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Indiana rates for HCPCS L3250

Orthopedic footwear, custom molded shoe, removable inner mold, prosthetic shoe, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$105.79 / $105.79 / $105.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.72 / $109.91 / $124.57
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$183.74 / $183.74 / $354.62
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$183.74 / $183.74 / $247.53
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$200.47 / $275.16 / $593.22
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$196.54 / $245.68 / $622.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$210.68 / $210.68 / $210.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.80 / $210.68 / $254.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.13 / $131.47 / $224.31