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Missouri 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
$118.40 / $118.40 / $184.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.40 / $121.18 / $137.33
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.22 / $183.74 / $230.36
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 / $217.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.34 / $194.33 / $1,166.45
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.12 / $142.69 / $338.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.16 / $138.13 / $274.89