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Texas rates for HCPCS L3257

Orthopedic footwear, additional charge for split size

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.17 / $11.80 / $12.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.31 / $12.03 / $17.32
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,456.92 / $5,821.21 / $8,577.84
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.00 / $18.00 / $22.50
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $80.00 / $80.00
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$115.05 / $119.23 / $119.23
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$155.47 / $161.69 / $183.90
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.81 / $19.87 / $36.33
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.30 / $10.81 / $19.87
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.06 / $79.78 / $81.79
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.81 / $19.87 / $34.77
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.51 / $20.51 / $28.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.73 / $13.97 / $26.09
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.20 / $54.93 / $54.93