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Louisiana 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
$25.40 / $26.97 / $36.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.44 / $26.12 / $29.31
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.90 / $69.89 / $98.24
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.90 / $33.36 / $33.36
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.97 / $29.97 / $29.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $21.88 / $52.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.99 / $20.49 / $34.58