go back

Indiana rates for HCPCS L5230

Above knee (AK), for proximal femoral focal deficiency, constant friction knee, shin, SACH foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,739.63 / $2,739.63 / $5,756.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,259.88 / $2,739.63 / $2,849.21
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,547.74 / $5,152.18 / $5,756.63
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,742.31 / $2,776.59 / $3,831.69
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,881.03 / $6,044.46 / $8,059.28
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,893.14 / $6,332.29 / $7,771.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,853.06 / $2,853.06 / $5,756.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,082.73 / $2,853.06 / $5,359.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,518.59 / $2,846.31 / $3,846.44