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Indiana rates for HCPCS L3201

Orthopedic shoe, Oxford with supinator or pronator, infant

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.02 / $17.02 / $17.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.36 / $17.68 / $20.04
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.47 / $41.47 / $80.04
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.64 / $41.47 / $55.86
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.65 / $62.21 / $96.42
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.61 / $40.44 / $93.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.06 / $30.06 / $30.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.94 / $30.06 / $51.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.30 / $21.50 / $36.08