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Indiana rates for HCPCS L5631

Addition to lower extremity, above knee (AK) or knee disarticulation, acrylic socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$250.98 / $250.98 / $527.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$250.98 / $257.50 / $293.26
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$369.15 / $395.52 / $395.52
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.61 / $471.99 / $527.36
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.26 / $319.89 / $431.86
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$395.52 / $580.10 / $791.04
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$448.26 / $580.10 / $711.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$329.53 / $329.53 / $527.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$240.56 / $329.53 / $540.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.40 / $263.08 / $396.41