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Washington, DC rates for HCPCS L5658

Addition To Lower Extremity Socket Insert Above Knee (Kemblo Pelite Aliplast Plastazote Or Equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$246.44 / $246.44 / $246.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$246.44 / $246.44 / $246.44
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.00 / $248.00 / $248.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$267.37 / $267.37 / $267.37
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$300.52 / $300.52 / $917.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.77 / $230.66 / $350.88