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Hawaii rates for HCPCS L3257

Orthopedic footwear, additional charge for split size

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.44 / $13.44 / $13.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.01 / $27.01 / $27.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.09 / $28.09 / $28.09
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.54 / $89.57 / $89.57
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.55 / $8.55 / $8.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.46 / $27.01 / $43.31