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Virginia 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
$116.58 / $140.50 / $140.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.58 / $140.50 / $140.50
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$183.74 / $183.74 / $225.92
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
$190.57 / $230.73 / $310.43
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.34 / $158.77 / $298.60
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$196.65 / $231.00 / $518.04
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$161.94 / $231.95 / $360.11
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.94 / $231.95 / $360.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.34 / $148.36 / $293.74