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Missouri rates for HCPCS L3640

Transfer of an orthosis from one shoe to another, Dennis Browne splint (Riveton), both shoes

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.14 / $27.14 / $36.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.79 / $28.13 / $42.93
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.85 / $54.44 / $239.34
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.77 / $27.25 / $41.95
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
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.86 / $41.97 / $242.56
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.23 / $25.87 / $63.03
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.89 / $23.21 / $41.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.18 / $25.87 / $39.35