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Indiana rates for HCPCS L5677

Additions to lower extremity, below knee (BK), knee joints, polycentric, pair

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$317.01 / $317.01 / $666.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.89 / $323.35 / $345.46
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$526.22 / $596.16 / $666.10
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$333.73 / $359.88 / $492.06
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$499.58 / $732.71 / $932.54
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$566.19 / $732.71 / $899.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$400.78 / $400.78 / $666.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.57 / $400.78 / $683.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$196.82 / $332.32 / $454.95