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Tennessee 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
$23.55 / $23.55 / $25.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.13 / $24.30 / $44.09
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.19 / $47.12 / $47.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.52 / $36.33 / $36.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.52 / $26.52 / $36.33
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.81 / $242.56 / $242.56
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$262.20 / $262.20 / $381.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.72 / $23.01 / $27.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.41 / $25.03 / $34.97