go back

South Carolina 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
$25.91 / $25.91 / $25.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.86 / $25.91 / $45.84
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.00 / $35.29 / $55.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.40 / $36.33 / $40.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.52 / $26.52 / $32.97
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.78 / $34.99 / $82.22
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.00 / $33.00 / $33.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.37 / $35.37 / $35.37
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.74 / $26.87 / $34.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.41 / $24.95 / $31.49