go back

West Virginia 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
$26.27 / $26.27 / $26.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.49 / $25.14 / $26.27
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.03 / $68.63 / $88.97
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.04 / $36.65 / $62.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.33 / $36.33 / $61.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.52 / $26.52 / $249.82
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.01 / $23.01 / $23.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.46 / $25.37 / $42.28