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Massachusetts rates for HCPCS L3003

Foot Insert Removable Molded To Patient Model Silicone Gel Each (Special Coverage Instructions Apply. See Mcm: 2323)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.54 / $89.54 / $89.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.54 / $98.70 / $131.25
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$136.50 / $426.12 / $977.65
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.96 / $146.66 / $200.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$149.11 / $149.11 / $149.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.85 / $149.11 / $243.38
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.94 / $165.94 / $174.24
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.60 / $108.60 / $108.60
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$426.12 / $977.65 / $977.65
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.98 / $102.25 / $200.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.30 / $109.54 / $200.14