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Minnesota 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
$31.28 / $31.28 / $31.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.32 / $22.62 / $31.28
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.57 / $45.02 / $62.71
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.02 / $42.77 / $45.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.97 / $138.63 / $385.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.13 / $55.25 / $66.20
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$82.30 / $133.01 / $303.18
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.13 / $52.13 / $53.60
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.96 / $45.02 / $196.70
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.99 / $20.12 / $45.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.08 / $33.59 / $77.17