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New York rates for HCPCS L3257

Orthopedic footwear, additional charge for split size

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.62 / $13.44 / $14.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.39 / $14.95 / $15.89
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.93 / $54.93 / $129.09
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
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.69 / $12.12 / $12.12
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.12 / $12.12 / $12.12
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.12 / $19.71 / $20.94
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.09 / $28.09 / $555.00
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.51 / $20.51 / $28.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.25 / $16.75 / $28.04
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.46 / $19.71 / $19.71
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.12 / $19.71 / $20.94