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Utah 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
$14.99 / $14.99 / $14.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.99 / $17.36 / $146.71
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 / $60.38
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.52 / $38.44 / $50.15
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.11 / $51.42 / $51.42
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.28 / $36.86 / $55.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.35 / $23.21 / $26.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.84 / $23.21 / $29.72