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Indiana rates for HCPCS L5690

Addition to lower extremity, below knee (BK), waist belt, padded and lined

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.69 / $71.69 / $150.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.13 / $71.69 / $74.56
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$119.01 / $134.82 / $150.63
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.54 / $71.42 / $98.55
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.83 / $158.16 / $210.90
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.04 / $165.70 / $203.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.44 / $97.44 / $150.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.13 / $97.44 / $131.90
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$187.92 / $187.92 / $187.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.06 / $75.15 / $100.65