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Indiana rates for HCPCS L5795

Addition, exoskeletal system, hip disarticulation, ultra-light material (titanium, carbon fiber or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$613.29 / $613.29 / $1,288.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$613.29 / $629.24 / $752.28
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,018.07 / $1,153.38 / $1,288.69
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.64 / $787.30 / $1,086.47
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,095.39 / $1,460.51 / $1,933.04
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,095.39 / $1,417.56 / $1,739.73
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$908.11 / $908.11 / $1,288.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$662.92 / $662.92 / $1,321.94
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,061.90 / $2,061.90 / $2,061.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$428.61 / $642.91 / $968.67