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Missouri rates for HCPCS L3257

Orthopedic footwear, additional charge for split size

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.68 / $11.68 / $18.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.68 / $11.95 / $13.55
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.12 / $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 / $20.51 / $28.09
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.81 / $19.17 / $115.05
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.25 / $14.08 / $33.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.06 / $14.01 / $26.49