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Indiana rates for HCPCS L5781

Addition To Lower Limb Prosthesis Vacuum Pump Residual Limb Volume Management And Moisture Evacuation System

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,298.77 / $2,298.77 / $4,830.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,298.77 / $2,358.54 / $2,403.67
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,815.93 / $4,323.10 / $4,830.29
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,420.00 / $2,902.12 / $4,004.92
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,642.34 / $5,313.32 / $7,245.44
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,105.75 / $5,313.32 / $6,520.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,886.72 / $2,886.72 / $4,830.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,107.31 / $2,886.72 / $4,954.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,904.03 / $6,904.03 / $6,904.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,435.14 / $2,409.78 / $3,414.19