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Maine 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
$150.72 / $173.96 / $173.96
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$183.74 / $183.74 / $183.74
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 / $155.75 / $210.68
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$235.32 / $235.32 / $235.32
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.86 / $173.96 / $173.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.32 / $134.99 / $379.05