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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
$1,148.15 / $1,148.15 / $1,148.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,148.15 / $1,445.44
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.02 / $2,454.71 / $3,090.30
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,122.02 / $2,041.74
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,862.09 / $2,344.23 / $2,818.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,174.90 / $1,174.90 / $2,454.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $851.14 / $2,041.74
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,230.27 / $1,445.44 / $1,949.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $1,202.26 / $1,621.81