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Maryland 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
$104.38 / $116.58 / $199.37
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 / $153.80 / $210.68
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$206.81 / $254.09 / $353.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.96 / $174.23 / $280.98
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$183.74 / $183.74 / $243.65