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Indiana rates for HCPCS L5613

Addition To Lower Extremity Endoskeletal System Above Knee- Knee Disarticulation 4 Bar Linkage With Hydraulic Swing Phase Control

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,399.85 / $1,399.85 / $2,941.43
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,399.85 / $1,436.25 / $1,635.70
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,323.73 / $2,632.58 / $2,941.43
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,473.67 / $1,788.71 / $2,468.41
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,267.58 / $3,235.57 / $4,412.14
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,500.21 / $3,235.57 / $3,970.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,902.78 / $1,902.78 / $2,941.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,389.03 / $1,902.78 / $3,017.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$978.30 / $1,467.45 / $2,210.98