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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
$10.00 / $15.85 / $23.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.00 / $12.02 / $19.95
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.38 / $27.54 / $54.95
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.91 / $97.72 / $169.82
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.18 / $83.18 / $117.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.18 / $28.18 / $28.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.42 / $20.42 / $28.18
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.18 / $28.18 / $28.18
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.42 / $20.42 / $28.18
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $151.36 / $181.97
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.96 / $14.45 / $21.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.51 / $12.88 / $20.89