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Pennsylvania rates for HCPCS L3100

Hallus-Valgus Night Dynamic Splint Prefabricated Off-The-Shelf (Revised 01/01/14) (Special Coverage Instructions Apply. See Mcm: 2323)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.92 / $20.92 / $80.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.89 / $24.04 / $30.74
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.71 / $50.84 / $50.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.89 / $34.89 / $50.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.47 / $25.47 / $44.52
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.77 / $50.84 / $96.60
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.96 / $38.96 / $38.96
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.92 / $20.92 / $80.95
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.89 / $24.49 / $45.84
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.60 / $14.00 / $100.20
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.89 / $34.89 / $50.84
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.47 / $25.47 / $60.38
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.35 / $48.39 / $48.39
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.35 / $48.39 / $49.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.46 / $25.62 / $45.85