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Wisconsin 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
$26.29 / $26.29 / $26.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.86 / $26.29 / $47.22
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.12 / $57.33 / $94.86
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.07 / $48.47 / $64.09
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.50 / $111.54 / $111.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.33 / $115.20 / $216.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.52 / $86.81 / $98.65
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.99 / $39.44 / $59.94
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.84 / $50.84 / $62.54
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.94 / $52.12 / $242.56
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.74 / $27.30 / $56.75
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.93 / $55.46 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.99 / $39.44 / $59.94
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.84 / $50.84 / $62.54
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.12 / $80.22 / $139.51
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.33 / $101.80 / $242.56
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.52 / $36.33 / $262.20
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.12 / $52.12 / $52.12
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.12 / $52.12 / $52.12
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $23.01 / $27.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.35 / $26.00 / $49.84