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Indiana rates for HCPCS L3002

Foot insert, removable, molded to patient model, Plastazote or equal, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$96.31 / $96.31 / $194.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.61 / $98.12 / $104.52
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.21 / $136.21 / $136.21
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$153.72 / $174.16 / $194.59
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.96 / $113.80 / $153.63
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$146.72 / $214.05 / $291.89
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.40 / $214.05 / $262.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$129.63 / $129.63 / $194.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.64 / $94.64 / $199.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.81 / $96.28 / $131.61