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Alaska rates for HCPCS L3257

Orthopedic footwear, additional charge for split size

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.81 / $21.81 / $21.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.09 / $28.09 / $28.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.51 / $28.09 / $29.94
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.81 / $10.81 / $10.81
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.61 / $21.61 / $30.88
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.75 / $87.75 / $87.75
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.81 / $10.81 / $28.09
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.51 / $28.09 / $29.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.68 / $23.61 / $39.35