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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
$338.84 / $338.84 / $338.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $354.81 / $549.54
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.38 / $724.44 / $912.01
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $407.38 / $724.44
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.08 / $831.76 / $1,000.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $416.87 / $724.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $309.03 / $630.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $512.86 / $562.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $354.81 / $512.86