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Indiana rates for HCPCS L5654

Addition to lower extremity, socket insert, Symes, (Kemblo, Pelite, Aliplast, Plastazote or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$225.25 / $225.25 / $473.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$197.02 / $225.25 / $234.26
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$373.91 / $423.60 / $473.30
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$230.88 / $240.07 / $331.29
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$338.34 / $497.56 / $662.62
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$402.31 / $520.63 / $638.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$306.16 / $306.16 / $473.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.50 / $306.16 / $468.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.38 / $236.12 / $314.95