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South Carolina rates for HCPCS L3257

Orthopedic footwear, additional charge for split size

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.40 / $10.40 / $10.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.40 / $10.40 / $20.87
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.00 / $189.00 / $245.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.09 / $28.09 / $41.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.51 / $20.51 / $28.09
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.40 / $12.90 / $32.64
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.00 / $12.00 / $12.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.38 / $12.82 / $19.78