go back

Montana rates for HCPCS L3640

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.03 / $146.71 / $146.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.33 / $55.28 / $55.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.33 / $55.28 / $55.28
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.94 / $52.65 / $55.28
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.50 / $42.41 / $55.33
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.87 / $26.87 / $29.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.98 / $23.21 / $35.53