go back

West 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
$115.45 / $115.45 / $115.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.91 / $117.78 / $161.15
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$203.38 / $256.14 / $332.03
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$219.02 / $219.02 / $41,999.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$210.68 / $210.68 / $245.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.80 / $210.68 / $1,027.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.29 / $191.72 / $328.32