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Georgia 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
$24.86 / $24.86 / $59.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.55 / $27.95 / $39.42
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.36 / $73.30 / $192.16
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.25 / $43.53 / $83.58
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.21 / $44.51 / $96.87
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.51 / $44.51 / $44.51
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 / $62.28
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.79 / $52.36 / $73.06
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.31 / $23.01 / $25.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.41 / $26.12 / $43.10