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Virginia rates for HCPCS L3257

Orthopedic footwear, additional charge for split size

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.50 / $13.86 / $13.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.50 / $13.86 / $13.86
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.93 / $54.93 / $67.54
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.80 / $22.76 / $30.62
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.81 / $15.66 / $29.90
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.00 / $15.97 / $51.10
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.97 / $22.98 / $37.44
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.97 / $22.98 / $37.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.04 / $15.74 / $28.06