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Indiana rates for HCPCS L3265

Plastazote sandal, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.03 / $6.46 / $6.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.03 / $7.08 / $12.02
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.92 / $26.92 / $51.29
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.49 / $26.92 / $47.86
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.02 / $14.79 / $48.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.89 / $28.84 / $28.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.89 / $20.89 / $28.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.31 / $8.71 / $16.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.75 / $8.51 / $14.45