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Alaska rates for HCPCS L3250

Orthopedic footwear, custom molded shoe, removable inner mold, prosthetic shoe, each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$221.08 / $221.08 / $221.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$210.68 / $210.68 / $210.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.80 / $210.68 / $217.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.34 / $109.34 / $109.34
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$219.12 / $219.12 / $313.02
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.34 / $109.34 / $210.68
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.80 / $210.68 / $219.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.99 / $305.77 / $400.76