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Indiana rates for HCPCS L4210

Repair Of Orthotic Device Repair Or Replace Minor Parts (Special Coverage Instructions Apply. See Mcm: 2133 2100.4 2130d)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.00 / $20.00 / $20.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.00 / $20.00 / $20.00
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$362.56 / $362.56 / $362.56
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.80 / $55.80 / $107.69
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.00 / $55.80 / $73.65
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.48 / $54.05 / $62.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.66 / $117.89 / $117.89