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Michigan 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
$119.88 / $119.88 / $119.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.61 / $119.88 / $119.88
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$317.70 / $633.00 / $1,152.91
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.41 / $209.91 / $283.38
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$133.21 / $136.44 / $137.19
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$167.93 / $167.93 / $167.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$149.11 / $149.11 / $149.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$149.11 / $149.11 / $243.38
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$119.88 / $151.69 / $151.69
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.88 / $151.69 / $220.40
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.03 / $155.33 / $178.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.98 / $98.58 / $150.25