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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
$16.98 / $16.98 / $16.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.98 / $19.95 / $30.20
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.69 / $41.69 / $79.43
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.69 / $41.69 / $72.44
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.62 / $97.72 / $138.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $21.88 / $54.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.85 / $22.91 / $38.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.14 / $22.91 / $38.90