go back

Idaho rates for HCPCS L3100

Hallus-Valgus Night Dynamic Splint Prefabricated Off-The-Shelf (Revised 01/01/14) (Special Coverage Instructions Apply. See Mcm: 2323)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.03 / $34.31 / $44.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.89 / $34.89 / $34.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.47 / $34.89 / $37.19
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.99 / $35.81 / $50.84
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.76 / $48.30 / $50.84
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $37.52 / $44.69
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.52 / $49.65 / $74.48
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.59 / $36.86 / $53.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.08 / $23.21 / $36.82