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California 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
Facility
Modifier
Low / Median / High Price
$27.95 / $27.95 / $146.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.21 / $27.95 / $146.71
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.23 / $77.16 / $161.38
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.42 / $27.25 / $48.47
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.40 / $74.97 / $107.50
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.48 / $91.74 / $157.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.33 / $36.33 / $40.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.52 / $26.52 / $60.38
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.82 / $16.57 / $55.92
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.50 / $35.59 / $78.80
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.56 / $242.56 / $242.56
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$262.20 / $262.20 / $381.30
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.33 / $107.33 / $107.33
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.99 / $44.95 / $52.36
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.52 / $26.52 / $49.65
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.97 / $95.97 / $95.97
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.82 / $23.49 / $40.67
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.84 / $21.08 / $23.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.08 / $23.21 / $49.49