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Oregon rates for HCPCS L3250

Orthopedic Footwear Custom Molded Shoe Removable Inner Mold Prosthetic Shoe Each (Special Coverage Instructions Apply. See Mcm: 2323)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$193.55 / $193.55 / $193.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.08 / $175.99 / $222.39
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 / $210.68
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$461.34 / $521.01 / $620.54
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$166.12 / $225.27 / $533.79
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$462.79 / $462.79 / $462.79
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$242.66 / $400.91 / $441.53
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$242.66 / $242.66 / $242.66
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$118.40 / $210.68 / $575.19
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.80 / $462.79 / $2,400,000.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$404.38 / $496.69 / $861.19
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$459.59 / $512.86 / $666.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.99 / $142.69 / $236.07