go back

Montana rates for HCPCS L3257

Orthopedic Footwear Additional Charge For Split Size (Special Coverage Instructions Apply. See Mcm: 2323)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.11 / $10.11 / $10.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.09 / $28.09 / $34.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.09 / $29.94 / $34.18
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.81 / $28.09 / $34.85
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.78 / $31.54 / $40.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.49 / $14.08 / $17.23