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Maine 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
Professional
Modifier
Low / Median / High Price
$97.95 / $124.40 / $124.40
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$182.27 / $236.15 / $437.75
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.00 / $75.00 / $119.68
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 / $108.85 / $149.11
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.94 / $165.94 / $165.94
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.39 / $124.40 / $124.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.09 / $102.25 / $235.12