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North Carolina rates for HCPCS L3257

Orthopedic footwear, additional charge for split size

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.87 / $20.87 / $20.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.50 / $20.87 / $20.87
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.56 / $14.60 / $15.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.09 / $28.09 / $40.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.51 / $28.09 / $32.00
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.81 / $20.87 / $31.38
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.00 / $12.00 / $15.23
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.60 / $29.60 / $29.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.23 / $13.45 / $20.51
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $119.23 / $119.23
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.69 / $183.90 / $183.90