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Michigan rates for HCPCS L3002

Foot insert, removable, molded to patient model, Plastazote or equal, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$111.13 / $111.13 / $111.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.31 / $111.13 / $111.13
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$294.52 / $586.80 / $1,068.77
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$184.86 / $194.59 / $262.70
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$123.45 / $126.48 / $127.17
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$155.66 / $155.66 / $155.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$129.63 / $129.63 / $129.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.64 / $161.80 / $282.19
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$111.13 / $140.61 / $140.61
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.74 / $140.61 / $204.31
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.40 / $144.00 / $165.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.27 / $91.38 / $139.27