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Indiana rates for HCPCS L5976

All lower extremity prostheses, energy storing foot (Seattle Carbon Copy II or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$337.63 / $337.63 / $709.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$332.69 / $344.38 / $373.78
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$560.47 / $634.96 / $709.45
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.00 / $409.90 / $558.89
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$532.09 / $780.40 / $1,008.26
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$603.03 / $780.40 / $957.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$420.01 / $420.01 / $709.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$306.61 / $420.01 / $727.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.56 / $353.93 / $508.78