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Hawaii rates for HCPCS L3995

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.53 / $22.53 / $22.53
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.83 / $36.83 / $36.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.97 / $51.01 / $51.01
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.37 / $48.55 / $48.55
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.82 / $46.37 / $64.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.97 / $36.83 / $51.01
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.27 / $37.35 / $44.13