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Illinois 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
$26.79 / $26.79 / $26.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.92 / $26.79 / $41.70
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.01 / $104.91 / $448.46
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.59 / $39.61 / $67.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.33 / $36.33 / $57.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.52 / $26.52 / $60.98
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.12 / $68.88 / $82.77
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.76 / $67.76 / $67.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.72 / $23.01 / $52.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.35 / $26.00 / $49.63