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New York 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
$17.30 / $22.13 / $40.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.30 / $22.21 / $32.04
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.84 / $51.86 / $101.68
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.25 / $27.25 / $78.36
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.39 / $42.36 / $42.36
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.36 / $42.36 / $42.36
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
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.84 / $114.39 / $332.00
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.25 / $37.61 / $91.51
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.84 / $30.84 / $30.84
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.69 / $30.84 / $37.01
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.33 / $36.33 / $555.00
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.52 / $31.16 / $78.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.48 / $23.01 / $26.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.91 / $26.39 / $46.53
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.18 / $29.69 / $29.69
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.69 / $29.69 / $31.55