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Alaska rates for HCPCS L3640

Transfer Of An Orthosis From One Shoe To Another Dennis Browne Splint (Riveton) Both Shoes (Special Coverage Instructions Apply. See Mcm: 2323)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.55 / $43.55 / $43.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.33 / $36.33 / $36.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.52 / $26.52 / $26.52
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.99 / $14.99 / $14.99
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.30 / $48.30 / $76.26
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.65 / $49.65 / $49.65
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.99 / $14.99 / $36.33
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.52 / $37.71 / $59.58
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.01 / $26.87 / $26.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.58 / $48.62 / $63.42