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Indiana rates for HCPCS L3257

Orthopedic footwear, additional charge for split size

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.43 / $10.43 / $10.43
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.02 / $10.84 / $12.29
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.93 / $54.93 / $106.01
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.67 / $54.93 / $72.50
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.39 / $181.12 / $187.07
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 / $31.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.38 / $12.91 / $21.74