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Indiana rates for HCPCS L5696

Addition to lower extremity, above knee (AK) or knee disarticulation, pelvic joint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.53 / $112.53 / $236.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.91 / $115.45 / $123.49
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.79 / $211.61 / $236.44
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.47 / $133.38 / $184.06
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.33 / $260.08 / $333.11
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.97 / $260.08 / $319.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.76 / $138.76 / $236.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.29 / $138.76 / $242.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$355.31 / $355.31 / $355.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.86 / $117.96 / $169.24