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Orthopedic Footwear, Additional Charge for Split Size

Washington rates for HCPCS L3257

Orthopedic footwear, additional charge for split size

Rates data updated July 2026.

Facilitymedian $44 · 10th–90th $22$560%20%10th90th$44Professionalmedian $22 · 10th–90th $14$540%20%10th90th$22$0.5$2.0$10.0$50.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$21.88
Median
$21.88
Typical High
$52.48
Aetna
Setting
Professional
Modifier
Global
Typical Low
$12.30
Median
$21.38
Typical High
$21.88
Asuris Northwest Health
Setting
Facility
Modifier
Global
Typical Low
$26.30
Median
$32.36
Typical High
$61.66
Cigna
Setting
Facility
Modifier
Global
Typical Low
$28.18
Median
$28.18
Typical High
$28.18
Cigna
Setting
Professional
Modifier
Global
Typical Low
$20.42
Median
$20.42
Typical High
$28.18
Kaiser Permanente
Setting
Facility
Modifier
Global
Typical Low
$22.91
Median
$47.86
Typical High
$66.07
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$22.91
Median
$47.86
Typical High
$58.88
Molina
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$50.12
Typical High
$75.86
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$42.66
Median
$43.65
Typical High
$53.70
Pacific Source
Setting
Professional
Modifier
Global
Typical Low
$53.70
Median
$53.70
Typical High
$53.70
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$29.51
Median
$29.51
Typical High
$29.51
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$29.51
Median
$40.74
Typical High
$57.54
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$26.92
Median
$32.36
Typical High
$61.66
United
Setting
Facility
Modifier
Global
Typical Low
$11.75
Median
$15.49
Typical High
$18.62
United
Setting
Professional
Modifier
Global
Typical Low
$13.18
Median
$16.60
Typical High
$23.99
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$22.39
Median
$47.86
Typical High
$54.95