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Alaska rates for HCPCS L3995

Addition to upper extremity orthosis, sock, fracture or equal, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$295.12 / $295.12 / $398.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.89 / $25.70 / $37.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $21.88 / $31.62
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.48 / $37.15 / $41.69
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.90 / $41.69 / $123.03
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.67 / $42.66 / $44.67
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.67 / $42.66 / $43.65
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.48 / $11.48 / $42.66
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $30.20 / $60.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.78 / $17.78 / $20.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.89 / $32.36 / $107.15