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Tennessee rates for HCPCS L3257

Orthopedic footwear, additional charge for split size

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.92 / $10.92 / $11.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.72 / $11.53 / $18.75
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.28 / $37.97 / $37.97
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.09 / $28.09 / $48.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.51 / $20.51 / $28.09
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $115.05 / $119.23
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$155.47 / $161.69 / $183.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.38 / $12.62 / $22.49