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Indiana rates for HCPCS L5650

Additions to lower extremity, total contact, above knee (AK) or knee disarticulation socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$278.86 / $278.86 / $585.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$278.86 / $286.11 / $325.83
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$410.16 / $439.46 / $439.46
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$462.89 / $524.41 / $585.94
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$285.83 / $355.30 / $479.65
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$439.46 / $644.53 / $878.91
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$498.05 / $644.53 / $791.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$379.03 / $379.03 / $585.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$276.69 / $276.69 / $601.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.88 / $292.32 / $440.44