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Illinois 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
$23.14 / $23.14 / $23.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.18 / $23.14 / $34.01
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.06 / $91.46 / $387.30
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.79 / $34.22 / $34.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.97 / $29.97 / $39.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $21.88 / $52.13
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.65 / $49.99 / $92.52
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.53 / $58.53 / $58.53
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.19 / $25.99 / $27.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.99 / $21.93 / $38.90