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Indiana rates for HCPCS L5200

Above knee (AK), molded socket, single axis constant friction knee, shin, SACH foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,088.40 / $2,088.40 / $4,388.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,088.40 / $2,142.69 / $2,204.87
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,466.72 / $3,927.48 / $4,388.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,198.52 / $2,396.26 / $3,306.83
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,292.69 / $4,827.08 / $6,582.38
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,730.01 / $4,827.08 / $5,924.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,728.17 / $2,728.17 / $4,388.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,991.56 / $1,991.56 / $4,501.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.72 / $2,189.23 / $3,048.16