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Texas rates for HCPCS L3201

Orthopedic shoe, Oxford with supinator or pronator, infant

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.22 / $19.25 / $19.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.82 / $19.62 / $28.27
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.00 / $18.00 / $18.00
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $80.00 / $80.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.06 / $30.06 / $30.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.94 / $21.94 / $30.06
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$187.60 / $194.47 / $194.47
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$249.13 / $259.10 / $299.85
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.55 / $32.40 / $58.96
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.16 / $17.55 / $32.40
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.17 / $49.47 / $50.72
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.55 / $30.06 / $56.63
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.94 / $21.94 / $30.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.13 / $22.77 / $42.45
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.47 / $41.47 / $45.07