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New Hampshire 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
$28.63 / $28.63 / $34.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.92 / $22.21 / $28.63
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.84 / $50.84 / $60.27
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.25 / $27.25 / $29.70
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 / $36.33
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.17 / $41.17 / $127.07
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.31 / $24.16 / $27.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.91 / $25.37 / $30.41
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.08 / $41.89 / $53.31