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Pennsylvania rates for HCPCS L2250

Addition to lower extremity, foot plate, molded to patient model, stirrup attachment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.83 / $691.83 / $691.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $208.93 / $363.08
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $363.08 / $363.08
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $8,511.38 / $77,624.71
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $436.52 / $436.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.19 / $251.19 / $407.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $186.21 / $251.19
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $537.03 / $776.25
Geisinger
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $446.68 / $446.68
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $288.40 / $446.68
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $302.00 / $323.59
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.83 / $177.83 / $691.83
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $213.80 / $478.63
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.65 / $645.65 / $645.65
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $549.54 / $794.33
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$309.03 / $309.03 / $416.87
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $309.03 / $416.87
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$199.53 / $549.54 / $660.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $218.78 / $389.05