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Indiana rates for HCPCS L8043

Upper facial prosthesis, provided by a nonphysician

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,160.26 / $2,160.26 / $4,539.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,160.26 / $2,203.46 / $2,252.98
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,585.99 / $4,062.61 / $4,539.22
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,160.46 / $2,478.96 / $3,420.97
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,815.71 / $4,312.29 / $6,127.96
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,906.50 / $4,527.89 / $5,821.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,600.52 / $3,600.52 / $4,539.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,060.44 / $3,600.52 / $4,600.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,347.50 / $2,264.57 / $3,114.68