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Indiana rates for HCPCS L5629

Addition to lower extremity, below knee, acrylic socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$181.53 / $181.53 / $381.43
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.53 / $186.25 / $217.83
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$267.00 / $267.00 / $286.07
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$301.33 / $341.38 / $381.43
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.08 / $231.73 / $312.83
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$286.07 / $419.57 / $572.15
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$324.22 / $419.57 / $514.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$248.05 / $248.05 / $381.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.08 / $248.05 / $358.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.86 / $190.30 / $286.70