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Connecticut rates for HCPCS L5697

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.66 / $61.66 / $61.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.74 / $57.54 / $91.20
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.33 / $131.83 / $158.49
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.54 / $61.66 / $69.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.26 / $60.26 / $60.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.65 / $43.65 / $43.65
ConnectiCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $83.18 / $83.18
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $87.10 / $109.65
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $61.66 / $61.66
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.81 / $63.10 / $67.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.86 / $64.57 / $83.18