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North Carolina 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
$33.11 / $102.33 / $102.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.85 / $22.91 / $33.11
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.54 / $32.36 / $44.67
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.90 / $37.15 / $75.86
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.18 / $28.84 / $30.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.98 / $30.20 / $30.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $21.88 / $37.15
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $23.44 / $26.30
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.22 / $33.11 / $57.54
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $0.60 / $0.60
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.30 / $17.78 / $30.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.45 / $18.62 / $27.54
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$199.53 / $199.53 / $199.53
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $234.42 / $363.08