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New Hampshire 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
$169.82 / $169.82 / $204.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $151.36 / $204.17
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $181.97 / $181.97
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$208.93 / $208.93 / $208.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $154.88 / $208.93
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $234.42 / $407.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.13 / $141.25 / $354.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $147.91 / $281.84
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.09 / $457.09 / $741.31