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Indiana rates for HCPCS L5628

Addition To Lower Extremity Test Socket Hemipelvectomy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$367.71 / $367.71 / $772.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.85 / $367.71 / $382.42
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$610.40 / $691.53 / $772.66
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$348.05 / $352.40 / $486.31
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$520.11 / $811.29 / $1,081.72
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.76 / $849.93 / $1,043.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$499.82 / $499.82 / $772.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$364.87 / $499.82 / $676.56
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.46 / $433.66 / $435.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$192.74 / $385.47 / $551.62