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Massachusetts 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
$21.00 / $21.00 / $21.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.36 / $21.00 / $27.07
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.25 / $91.39 / $199.55
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.61 / $28.91 / $46.94
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.80 / $27.80 / $82.57
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.48 / $32.51 / $32.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.80 / $29.97 / $33.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $21.88 / $52.13
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.90 / $38.90 / $40.86
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.97 / $23.97 / $23.97
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.39 / $199.55 / $199.55
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.98 / $23.98 / $46.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.98 / $28.84 / $46.94