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Connecticut rates for HCPCS L5695

Addition to lower extremity, above knee (AK), pelvic control, sleeve suspension, neoprene or equal, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.12 / $107.12 / $107.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.15 / $107.12 / $117.44
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$170.79 / $220.38 / $252.14
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.12 / $120.12 / $124.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$122.31 / $122.31 / $122.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.29 / $89.29 / $122.31
ConnectiCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$143.25 / $143.25 / $143.25
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$143.25 / $147.97 / $209.45
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.71 / $127.71 / $127.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.90 / $109.94 / $150.47