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Indiana rates for HCPCS L5679

Addition To Lower Extremity Below Knee/Above Kneecustom Fabricated Fromexisting Mold Or Prefabric Ated Socket Insert Silicone Gel Elastomeric Or Equal Not For Use With Locking Mechanism

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$376.29 / $376.29 / $790.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$351.99 / $376.29 / $391.34
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$553.48 / $593.01 / $790.68
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$624.64 / $707.66 / $790.68
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$385.71 / $424.98 / $586.47
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$593.01 / $869.75 / $1,106.95
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$672.08 / $869.75 / $1,067.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$440.05 / $440.05 / $790.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$321.24 / $440.05 / $811.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$222.28 / $394.46 / $528.29