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Pennsylvania rates for HCPCS L3257

Orthopedic footwear, additional charge for split size

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.98 / $11.45 / $44.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.84 / $11.62 / $14.87
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.88 / $13.36 / $13.36
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
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.45 / $11.45 / $44.31
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.81 / $11.45 / $13.44
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.09 / $28.09 / $28.09
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.51 / $20.51 / $28.09
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.35 / $46.35 / $46.35
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.35 / $46.35 / $46.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.69 / $15.19 / $26.82