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Vermont 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
Professional
Modifier
Low / Median / High Price
$141.85 / $141.85 / $170.86
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 / $210.68 / $333.92
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$210.68 / $210.68 / $210.68
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.80 / $210.68 / $333.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.89 / $220.29 / $370.86