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Pennsylvania 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
$111.35 / $116.08 / $449.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.91 / $117.78 / $150.72
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$244.40 / $253.63 / $253.63
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
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$116.08 / $116.08 / $449.23
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.34 / $117.78 / $136.43
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$271.20 / $271.20 / $271.20
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$210.68 / $210.68 / $210.68
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.80 / $153.80 / $401.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.56 / $153.97 / $272.23