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Indiana 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
$22.28 / $22.28 / $45.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.05 / $22.28 / $24.18
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.52 / $31.52 / $39.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.57 / $40.29 / $45.02
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.61 / $22.33 / $30.81
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.04 / $47.27 / $63.03
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.27 / $49.52 / $60.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.97 / $29.97 / $45.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $21.88 / $46.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.99 / $20.94 / $30.09