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Indiana rates for HCPCS L5637

Addition to lower extremity, below knee (BK), total contact

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$220.02 / $220.02 / $462.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$171.62 / $220.02 / $228.82
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.62 / $323.62 / $346.73
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$365.22 / $413.77 / $462.31
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.25 / $210.73 / $290.80
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$300.50 / $485.43 / $647.23
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$392.96 / $508.54 / $624.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$232.98 / $232.98 / $462.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.08 / $232.98 / $404.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.32 / $230.64 / $323.83