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Utah rates for HCPCS L3640

Transfer of an orthosis from one shoe to another, Dennis Browne splint (Riveton), both shoes

Facilitymedian $27 · 10th–90th $14–$520%20%40%10th90th$27Professionalmedian $36 · 10th–90th $14–$2190%10%10th90th$36$20.0$50.0$100.0$200.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$14.13 / $14.13 / $14.13
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$14.13 / $28.84 / $218.78
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$36.31 / $36.31 / $36.31
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$26.30 / $26.30 / $36.31
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $38.02 / $50.12
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$50.12 / $52.48 / $52.48
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$36.31 / $38.02 / $57.54
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $52.48 / $53.70
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.02 / $53.70 / $61.66
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$19.50 / $22.91 / $26.92
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$18.20 / $23.44 / $38.90