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Indiana rates for HCPCS L5697

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.70 / $53.70 / $53.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.66 / $53.70 / $83.18
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.54 / $114.82 / $144.54
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.54 / $57.54 / $104.71
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.50 / $120.23 / $144.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.26 / $60.26 / $114.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.65 / $43.65 / $93.33
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.10 / $74.13 / $89.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $54.95 / $75.86