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Indiana rates for HCPCS L5614

Addition to lower extremity, exoskeletal system, above knee (AK), knee disarticulation, four-bar linkage, with pneumatic swing phase control

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$969.49 / $969.49 / $2,037.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$969.49 / $994.70 / $1,013.73
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,609.34 / $1,823.24 / $2,037.14
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,020.61 / $1,111.77 / $1,534.24
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,536.13 / $2,240.85 / $3,055.71
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,731.57 / $2,240.85 / $2,750.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,317.79 / $1,317.79 / $2,037.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$961.99 / $1,317.79 / $2,089.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$605.26 / $1,016.30 / $1,399.02