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Illinois rates for HCPCS L3050

Foot Arch Support Removable Premolded Metatarsal Each (Special Coverage Instructions Apply. See Mcm: 2323)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.15 / $29.15 / $29.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.77 / $29.55 / $38.32
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$68.37 / $115.67 / $487.91
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.78 / $43.10 / $43.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.65 / $31.65 / $62.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.10 / $31.65 / $65.63
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.21 / $66.47 / $82.23
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.72 / $73.72 / $73.72
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.92 / $42.75 / $44.88
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.11 / $25.04 / $56.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.06 / $28.30 / $48.57