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Wisconsin rates for HCPCS L3640

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

Facilitymedian $54 · 10th–90th $48–$980%50%10th90th$54Professionalmedian $35 · 10th–90th $23–$790%20%10th90th$35$0.1$0.2$1.0$5.0$20.0$100.0

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
$25.70 / $25.70 / $25.70
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$21.88 / $25.70 / $38.02
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$53.70 / $53.70 / $87.10
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $48.98 / $58.88
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$36.31 / $123.03 / $263.03
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$26.30 / $75.86 / $100.00
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$26.30 / $42.66 / $66.07
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$29.51 / $51.29 / $63.10
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$26.30 / $52.48 / $239.88
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$23.44 / $27.54 / $57.54
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$28.84 / $58.88 / $70.79
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$83.18 / $83.18 / $83.18
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.02 / $60.26 / $104.71
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $79.43 / $147.91
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$36.31 / $104.71 / $239.88
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$26.30 / $52.48 / $263.03
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$15.85 / $26.92 / $53.70
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$18.20 / $25.70 / $44.67