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Washington 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
$222.39 / $504.83 / $527.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.70 / $222.39 / $222.39
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$282.97 / $1,166.45 / $1,166.45
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.54 / $252.70 / $1,918.35
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
Facility
Modifier
Low / Median / High Price
$206.46 / $464.53 / $750.27
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$206.46 / $438.09 / $602.61
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.00 / $50.00 / $75.00
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$242.66 / $400.91 / $441.53
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$242.66 / $242.66 / $242.66
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$274.20 / $329.04 / $601.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.57 / $157.02 / $237.83
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.18 / $156.18 / $183.74