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Indiana rates for HCPCS L5665

Addition to lower extremity, socket insert, multidurometer, below knee (BK)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$331.13 / $331.13 / $331.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $338.84 / $549.54
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$371.54 / $707.95 / $891.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $371.54 / $676.08
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$616.60 / $776.25 / $912.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.09 / $457.09 / $707.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $331.13 / $575.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.38 / $489.78 / $562.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $346.74 / $467.74