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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
$22.39 / $22.39 / $22.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.20 / $21.88 / $29.51
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.54 / $33.88 / $38.90
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.39 / $45.71 / $57.54
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.38 / $22.39 / $39.81
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.02 / $46.77 / $56.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.88 / $30.20 / $45.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $21.88 / $39.81
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.80 / $25.12 / $36.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.02 / $21.38 / $30.20