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Idaho 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
$16.55 / $27.01 / $35.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.34 / $29.97 / $29.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $21.88 / $37.85
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.61 / $29.27 / $40.02
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.02 / $38.02 / $40.02
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.83 / $29.89 / $35.17
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.04 / $39.08 / $58.62
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.01 / $28.01 / $42.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.63 / $17.98 / $27.72