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Indiana rates for HCPCS L5971

All lower extremity prostheses, solid ankle cushion heel (SACH) foot, replacement only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.89 / $125.89 / $125.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $131.83 / $194.98
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$147.91 / $269.15 / $331.13
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $147.91 / $269.15
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.47 / $302.00 / $363.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$158.49 / $158.49 / $269.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $117.49 / $229.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.18 / $190.55 / $208.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $131.83 / $186.21