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Washington rates for HCPCS L3250

Orthopedic footwear, custom molded shoe, removable inner mold, prosthetic shoe, each

Facilitymedian $417 · 10th–90th $224–$5890%10%20%10th90th$417Professionalmedian $200 · 10th–90th $115–$5010%10%10th90th$200$1.0$5.0$20.0$100.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$223.87 / $223.87 / $524.81
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $151.36 / $223.87
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$275.42 / $331.13 / $660.69
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$208.93 / $208.93 / $208.93
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $154.88 / $208.93
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$208.93 / $467.74 / $676.08
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$234.42 / $467.74 / $630.96
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $50.12 / $75.86
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$239.88 / $363.08 / $436.52
Pacific Source
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $239.88 / $239.88
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$295.12 / $302.00 / $302.00
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$302.00 / $416.87 / $575.44
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$275.42 / $331.13 / $707.95
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$112.20 / $144.54 / $190.55
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $158.49 / $245.47
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$128.82 / $154.88 / $275.42