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Kentucky rates for HCPCS L5658

Addition to lower extremity, socket insert, above knee (AK) (Kemblo, Pelite, Aliplast, Plastazote or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$158.63 / $207.69 / $215.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$185.43 / $229.57 / $292.08
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$271.66 / $436.40 / $458.66
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$219.64 / $262.11 / $274.55
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$327.30 / $615.32 / $829.16
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.40 / $589.14 / $767.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$366.26 / $366.26 / $571.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$267.37 / $366.26 / $2,393.37
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$228.06 / $278.13 / $347.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$145.13 / $223.19 / $345.30