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Washington rates for HCPCS L3640

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

Facilitymedian $51 · 10th–90th $34–$1170%20%10th90th$51Professionalmedian $34 · 10th–90th $22–$740%10%10th90th$34$0.5$2.0$10.0$50.0$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$33.88 / $33.88 / $81.28
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$21.88 / $26.92 / $44.67
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$43.65 / $50.12 / $50.12
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$43.65 / $43.65 / $57.54
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
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$28.84 / $66.07 / $144.54
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$28.84 / $60.26 / $107.15
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $51.29 / $75.86
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$40.74 / $50.12 / $51.29
Pacific Source
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $51.29 / $52.48
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$44.67 / $74.13 / $102.33
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$42.66 / $42.66 / $50.12
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$50.12 / $50.12 / $50.12
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$43.65 / $43.65 / $57.54
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$22.91 / $75.86 / $75.86
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$21.38 / $25.12 / $44.67
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$23.99 / $43.65 / $77.62