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Washington, DC 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
$16.09 / $16.09 / $16.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.09 / $16.09 / $21.66
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.00 / $21.00 / $21.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $21.88 / $21.88
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.56 / $25.56 / $78.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.08 / $19.61 / $30.53