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Indiana rates for HCPCS L5697

Addition To Lower Extremity Above Knee Or Knee Disarticulation Pelvic Band

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.44 / $53.44 / $112.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.69 / $53.58 / $55.57
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$88.70 / $100.49 / $112.28
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.26 / $57.87 / $79.86
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.90 / $120.44 / $157.19
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.44 / $123.51 / $151.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.21 / $60.21 / $112.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.95 / $60.21 / $105.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.04 / $56.02 / $75.03