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Indiana rates for HCPCS L5643

Addition to lower extremity, hip disarticulation, flexible inner socket, external frame

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,150.92 / $1,150.92 / $2,418.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$916.04 / $1,150.92 / $1,196.95
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,910.50 / $2,164.42 / $2,418.36
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,121.99 / $1,131.33 / $1,561.24
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,587.89 / $2,539.28 / $3,385.70
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,055.61 / $2,660.20 / $3,264.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,167.30 / $1,167.30 / $2,418.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$852.13 / $1,167.30 / $2,117.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$621.32 / $1,206.49 / $1,607.37