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Indiana rates for HCPCS L5850

Addition, endoskeletal system, above knee (AK) or hip disarticulation, knee extension assist

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$73.06 / $73.06 / $153.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.06 / $74.97 / $85.39
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.30 / $137.41 / $153.54
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.90 / $93.24 / $125.87
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$115.16 / $168.89 / $230.31
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.51 / $168.89 / $207.28
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.32 / $99.32 / $153.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.50 / $99.32 / $157.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.07 / $76.59 / $115.42