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Indiana rates for HCPCS L5500

Initial, below knee (BK) PTB type socket, nonalignable system, pylon, no cover, SACH foot, plaster socket, direct formed

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$847.23 / $847.23 / $1,780.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$762.95 / $857.21 / $881.11
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,406.38 / $1,593.31 / $1,780.23
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.91 / $1,707.00 / $2,299.67
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,310.28 / $1,926.88 / $2,492.32
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.20 / $1,958.25 / $2,403.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$963.22 / $963.22 / $1,780.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$703.15 / $963.22 / $2,064.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.69 / $888.14 / $1,189.50