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Indiana rates for HCPCS L3265

Plastazote sandal, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.42 / $6.42 / $6.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.39 / $6.67 / $8.77
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.62 / $26.62 / $51.38
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.58 / $26.62 / $35.93
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.93 / $48.75 / $48.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.65 / $28.65 / $28.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.91 / $20.91 / $30.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.78 / $8.07 / $13.62