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Indiana rates for HCPCS L2622

Addition to lower extremity, pelvic control, hip joint, adjustable flexion, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$189.76 / $189.76 / $383.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$182.46 / $189.76 / $205.93
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.89 / $343.14 / $383.40
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$187.04 / $210.09 / $289.92
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$287.55 / $421.74 / $536.76
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$325.89 / $421.74 / $517.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$215.87 / $215.87 / $383.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$157.59 / $215.87 / $393.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.90 / $186.72 / $259.37