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Minnesota 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
$166.12 / $166.12 / $166.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.01 / $166.12 / $208.10
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$123.75 / $126.23 / $809.38
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.98 / $123.75 / $126.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$210.68 / $690.04 / $1,916.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $405.64 / $510.06
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$409.67 / $662.06 / $1,509.09
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$357.45 / $401.63 / $401.63
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.34 / $318.20 / $1,166.45
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.13 / $144.41 / $318.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.13 / $173.67 / $400.46