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Nebraska 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
$133.24 / $133.24 / $133.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.24 / $133.24 / $173.02
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$183.63 / $202.00 / $204.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$149.11 / $229.83 / $229.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$149.11 / $229.83 / $354.39
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$105.18 / $228.70 / $977.65
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.09 / $104.23 / $173.72
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.16 / $229.83 / $289.57
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$205.00 / $271.62 / $473.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.00 / $104.23 / $133.88