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Washington, DC 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
$53.70 / $53.70 / $53.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.69 / $53.70 / $85.11
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.70 / $53.70 / $70.79
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 / $64.57
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.61 / $144.54 / $199.53
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$158.49 / $158.49 / $158.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.88 / $52.48 / $77.62