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Indiana rates for HCPCS L3221

Orthopedic footwear, mens shoe, depth inlay, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.74 / $41.74 / $41.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.54 / $43.36 / $49.15
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$82.15 / $82.15 / $158.55
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.15 / $82.15 / $113.36
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.78 / $100.80 / $137.81
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.91 / $93.05 / $133.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.84 / $69.84 / $69.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.99 / $69.84 / $108.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.53 / $52.15 / $88.50