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Indiana rates for HCPCS L5642

Addition to lower extremity, above knee (AK), leather socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$390.21 / $390.21 / $819.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$366.25 / $398.01 / $413.53
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$647.74 / $733.83 / $819.92
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$410.79 / $454.30 / $618.30
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$614.94 / $901.91 / $1,147.89
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$696.93 / $901.91 / $1,106.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$530.41 / $530.41 / $819.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$387.20 / $387.20 / $841.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$247.32 / $409.05 / $571.67