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Indiana rates for HCPCS L5655

Addition to lower extremity, socket insert, below knee (BK) (Kemblo, Pelite, Aliplast, Plastazote or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.63 / $162.63 / $341.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.63 / $166.86 / $177.03
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$269.97 / $305.85 / $341.73
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.71 / $201.58 / $272.20
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$256.30 / $375.90 / $506.00
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$290.47 / $375.90 / $461.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$221.07 / $221.07 / $341.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.38 / $221.07 / $350.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.88 / $170.48 / $241.52