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Indiana rates for HCPCS L5301

Below knee (BK), molded socket, shin, SACH foot, endoskeletal system

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,539.24 / $1,539.24 / $3,234.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,532.46 / $1,570.02 / $1,634.07
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,264.02 / $2,264.02 / $2,425.73
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,555.11 / $2,894.72 / $3,234.32
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,577.81 / $1,972.92 / $2,722.62
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,476.14 / $3,557.75 / $4,851.47
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,749.17 / $3,557.75 / $4,366.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,721.98 / $1,721.98 / $3,234.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,257.05 / $1,721.98 / $3,317.79
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,409.26 / $4,409.26 / $4,409.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$916.56 / $1,613.57 / $2,161.09