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Indiana rates for HCPCS L5626

Addition to lower extremity, test socket, hip disarticulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$363.08 / $363.08 / $363.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $363.08 / $446.68
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$346.74 / $776.25 / $977.24
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $346.74 / $616.60
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.44 / $707.95 / $851.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $489.78 / $776.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $363.08 / $630.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.19 / $436.52 / $616.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $380.19 / $512.86