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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
$363.12 / $363.12 / $763.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$283.23 / $363.12 / $377.64
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$602.78 / $682.89 / $763.01
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$343.70 / $345.85 / $475.82
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$495.96 / $801.16 / $1,068.21
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$648.55 / $839.31 / $1,030.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$493.58 / $493.58 / $763.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$360.31 / $493.58 / $668.12
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$915.61 / $915.61 / $915.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.33 / $380.66 / $504.60