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Massachusetts rates for HCPCS L3250

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$150.72 / $150.72 / $150.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.12 / $150.72 / $208.59
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$200.00 / $630.79 / $1,208.97
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.29 / $262.58 / $430.01
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 / $401.63
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$235.32 / $235.32 / $247.09
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$139.85 / $139.85 / $139.85
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$423.47 / $1,208.97 / $1,208.97
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.37 / $169.96 / $348.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.37 / $176.96 / $302.27