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Ohio rates for HCPCS L3257

Orthopedic footwear, additional charge for split size

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.84 / $10.84 / $136.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.77 / $10.84 / $15.15
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.34 / $24.75 / $54.93
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.16 / $187.07 / $327.37
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.09 / $159.01 / $196.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.24 / $28.09 / $28.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.51 / $20.51 / $28.09
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.09 / $28.09 / $28.09
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.51 / $28.09 / $28.09
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.57 / $152.42 / $180.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.58 / $12.89 / $21.46