go back

South Carolina 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
$105.44 / $105.44 / $105.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.44 / $105.44 / $211.63
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$174.00 / $224.54 / $294.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.00 / $210.68 / $221.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.80 / $188.88 / $210.68
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$105.44 / $130.75 / $327.58
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$231.00 / $231.00 / $231.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.74 / $129.96 / $211.40