go back

Indiana rates for HCPCS L5622

Addition to lower extremity, test socket, knee disarticulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.46 / $229.46 / $482.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$215.36 / $234.05 / $249.89
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.90 / $431.52 / $482.15
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$241.55 / $263.79 / $361.79
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$361.61 / $530.37 / $675.01
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$409.83 / $530.37 / $650.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$274.54 / $274.54 / $482.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.41 / $200.41 / $494.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.72 / $240.54 / $334.51