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Indiana rates for HCPCS L5684

Addition to lower extremity, below knee, fork strap

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.54 / $27.54 / $27.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.92 / $30.20 / $47.86
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.48 / $58.88 / $74.13
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.67 / $35.48 / $58.88
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.54 / $72.44 / $87.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.15 / $37.15 / $58.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.54 / $27.54 / $50.12
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.02 / $45.71 / $45.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.05 / $28.84 / $43.65