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Pennsylvania rates for HCPCS L3000

Foot insert, removable, molded to patient model, UCB type, Berkeley shell, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$151.36 / $588.84 / $588.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $281.84 / $870.96
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $281.84 / $371.54
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
$371.54 / $371.54 / $371.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$208.93 / $208.93 / $380.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $154.88 / $208.93
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $489.78 / $707.95
Geisinger
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.19 / $380.19 / $380.19
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $263.03 / $380.19
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.33 / $794.33 / $794.33
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $295.12 / $295.12
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$151.36 / $151.36 / $588.84
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $234.42 / $794.33
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$199.53 / $199.53 / $602.56
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $199.53 / $575.44
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.42 / $263.03 / $263.03
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $354.81 / $776.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.96 / $457.09 / $549.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $186.21 / $331.13