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Maine rates for HCPCS L3257

Orthopedic footwear, additional charge for split size

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.87 / $17.16 / $17.16
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.93 / $54.93 / $54.93
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 / $28.09
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.94 / $52.94 / $52.94
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.05 / $17.16 / $17.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.40 / $17.45 / $37.38