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Connecticut rates for HCPCS L5696

Addition to lower extremity, above knee (AK) or knee disarticulation, pelvic joint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.32 / $138.32 / $138.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.97 / $116.64 / $138.32
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$220.55 / $284.58 / $325.58
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.38 / $133.38 / $141.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.76 / $138.76 / $138.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.29 / $101.29 / $138.76
ConnectiCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$184.98 / $184.98 / $184.98
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.79 / $184.98 / $241.89
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.10 / $141.10 / $141.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.35 / $141.97 / $181.38