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Nebraska 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
$22.99 / $22.99 / $22.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.50 / $22.99 / $23.82
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.04 / $27.04 / $27.04
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.68 / $34.85 / $35.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.97 / $39.65 / $39.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.57 / $46.32 / $65.16
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.56 / $39.53 / $196.70
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.72 / $17.98 / $29.97
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.53 / $39.65 / $54.77
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.90 / $47.52 / $81.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.72 / $17.98 / $27.72