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Nebraska rates for HCPCS L3257

Orthopedic footwear, additional charge for split size

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.47 / $13.47 / $13.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.47 / $13.47 / $13.47
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.57 / $19.32 / $19.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.09 / $28.09 / $28.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.75 / $30.94 / $43.49
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.39 / $23.57 / $115.05
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.52 / $13.04 / $22.12
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.48 / $34.52 / $54.40
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.35 / $38.38 / $58.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.52 / $13.04 / $21.32