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Tennessee 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
$110.76 / $110.76 / $121.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.71 / $116.91 / $187.82
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.73 / $317.33 / $317.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$210.68 / $210.68 / $527.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.80 / $153.80 / $210.68
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$423.47 / $1,208.97 / $1,208.97
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,545.97 / $1,607.81 / $1,864.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.13 / $128.00 / $228.24