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Maryland rates for HCPCS L3257

Orthopedic footwear, additional charge for split size

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.00 / $12.02 / $19.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.18 / $28.18 / $28.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.42 / $20.42 / $28.18
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.95 / $25.70 / $40.74
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.00 / $14.13 / $17.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.88 / $17.38 / $29.51
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.91 / $54.95 / $54.95