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Missouri 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
$18.20 / $18.20 / $20.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.85 / $20.89 / $43.65
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.54 / $27.54 / $33.88
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.15 / $37.15 / $128.82
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.89 / $22.39 / $33.88
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $21.88 / $37.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.60 / $30.20 / $30.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $21.88 / $30.20
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.05 / $29.51 / $194.98
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.80 / $17.78 / $234.42
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.60 / $28.84 / $28.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.80 / $17.78 / $27.54