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Indiana rates for HCPCS L5700

Replacement, socket, below knee (BK), molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,762.25 / $1,762.25 / $3,702.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,702.07 / $1,797.50 / $1,832.74
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,592.05 / $2,592.05 / $2,592.05
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,925.31 / $3,314.12 / $3,702.93
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,806.41 / $2,055.03 / $2,835.94
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,777.20 / $4,073.22 / $5,184.10
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,147.49 / $4,073.22 / $4,998.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,400.00 / $2,400.00 / $3,702.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,752.00 / $2,400.00 / $3,798.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,093.20 / $1,847.35 / $2,526.89