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Indiana rates for HCPCS L5782

Addition to lower limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system, heavy-duty

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,398.83 / $2,398.83 / $2,398.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,238.72 / $2,511.89 / $3,801.89
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,754.23 / $5,248.07 / $6,456.54
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,511.89 / $2,754.23 / $5,011.87
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,128.61 / $6,456.54 / $7,762.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,951.21 / $3,311.31 / $5,248.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398.83 / $2,398.83 / $4,466.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,019.95 / $3,630.78 / $4,073.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $2,511.89 / $3,467.37