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Nebraska 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
$136.61 / $136.61 / $136.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.61 / $136.61 / $136.61
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$178.08 / $195.88 / $197.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$210.68 / $210.68 / $210.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$210.68 / $350.00 / $502.03
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.57 / $239.07 / $1,166.45
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.48 / $130.66 / $224.31
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$268.44 / $319.74 / $506.55
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$267.12 / $389.02 / $551.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.56 / $129.71 / $216.83