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South Carolina 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
$25.12 / $25.12 / $25.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.38 / $25.70 / $44.67
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.18 / $50.12 / $61.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.36 / $36.31 / $83.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.30 / $26.30 / $60.26
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.30 / $26.30 / $33.88
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.55 / $38.02 / $81.28
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.79 / $14.79 / $15.14
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $35.48
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $26.92 / $63.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.50 / $25.70 / $33.11