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Indiana rates for HCPCS L5857

Addition To Lower Proximity Prosthesis Endoskeletal Knee-Shin System

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,893.88 / $4,893.88 / $10,283.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,893.88 / $5,021.12 / $5,129.24
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,123.77 / $9,203.51 / $10,283.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,151.95 / $5,635.06 / $7,776.38
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,754.21 / $11,311.58 / $15,424.88
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,740.76 / $11,311.58 / $13,882.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,652.12 / $6,652.12 / $10,283.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,856.05 / $6,652.12 / $10,548.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,067.77 / $5,130.20 / $7,091.00