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Indiana rates for HCPCS L3100

Hallus-Valgus Night Dynamic Splint Prefabricated Off-The-Shelf (Revised 01/01/14) (Special Coverage Instructions Apply. See Mcm: 2323)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.80 / $25.80 / $52.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.81 / $26.78 / $28.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.17 / $46.65 / $52.12
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.49 / $27.25 / $37.60
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.27 / $57.33 / $78.18
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.30 / $57.33 / $70.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.89 / $34.89 / $52.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.47 / $34.89 / $53.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.48 / $24.91 / $35.22