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New Mexico 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
$25.67 / $25.67 / $25.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.67 / $39.42 / $146.71
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 / $64.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.88 / $52.36 / $78.54
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.99 / $14.99 / $39.35
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.52 / $36.33 / $61.01
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.89 / $23.01 / $25.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.08 / $23.21 / $34.97