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Washington rates for HCPCS L3252

Foot Shoe Molded To Patient Model Plastazote (Or Similar) Custom Fabricated Each (Special Coverage Instructions Apply. See Mcm: 2323)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.82 / $276.52 / $288.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.86 / $121.82 / $121.82
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$155.02 / $638.99 / $638.99
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.54 / $157.91 / $1,050.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.50 / $56.50 / $56.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.25 / $41.25 / $56.50
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$113.15 / $254.58 / $410.99
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.15 / $240.12 / $330.48
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
$196.03 / $219.62 / $241.87
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$196.03 / $196.03 / $196.03
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$150.21 / $180.26 / $329.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.00 / $91.20 / $130.28
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$152.51 / $152.51 / $157.91