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Orthopedic Footwear, Additional Charge for Split Size

Wisconsin rates for HCPCS L3257

Orthopedic footwear, additional charge for split size

Rates data updated July 2026.

Facilitymedian $22 · 10th–90th $11$1100%10%10th90th$22Professionalmedian $17 · 10th–90th $11$550%20%10th90th$17$0.0$0.1$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
$10.96
Median
$10.96
Typical High
$10.96
Aetna
Setting
Professional
Modifier
Global
Typical Low
$10.96
Median
$10.96
Typical High
$16.22
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$22.39
Median
$54.95
Typical High
$54.95
Cigna
Setting
Facility
Modifier
Global
Typical Low
$28.18
Median
$67.61
Typical High
$109.65
Cigna
Setting
Professional
Modifier
Global
Typical Low
$20.42
Median
$27.54
Typical High
$31.62
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$10.96
Median
$16.98
Typical High
$42.66
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$23.44
Median
$61.66
Typical High
$83.18
Medica
Setting
Facility
Modifier
Global
Typical Low
$10.96
Median
$21.38
Typical High
$114.82
Medica
Setting
Professional
Modifier
Global
Typical Low
$12.88
Median
$16.60
Typical High
$34.67
Molina
Setting
Professional
Modifier
Global
Typical Low
$33.88
Median
$54.95
Typical High
$70.79
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$10.96
Median
$16.98
Typical High
$42.66
Prevea360
Setting
Professional
Modifier
Global
Typical Low
$18.62
Median
$18.62
Typical High
$18.62
Quartz
Setting
Professional
Modifier
Global
Typical Low
$28.84
Median
$51.29
Typical High
$72.44
Quartz
Setting
Facility
Modifier
Global
Typical Low
$28.18
Median
$42.66
Typical High
$141.25
Quartz
Setting
Professional
Modifier
Global
Typical Low
$20.42
Median
$33.11
Typical High
$162.18
United
Setting
Facility
Modifier
Global
Typical Low
$10.00
Median
$15.49
Typical High
$17.78
United
Setting
Professional
Modifier
Global
Typical Low
$8.91
Median
$14.13
Typical High
$25.12