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New York 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
$16.36 / $20.92 / $38.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.18 / $21.00 / $30.30
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.25 / $35.25 / $35.25
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.06 / $49.02 / $96.12
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.33 / $22.33 / $70.20
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.25 / $40.04 / $40.04
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.04 / $40.04 / $40.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.97 / $29.97 / $29.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $21.88 / $29.97
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.06 / $108.14 / $332.00
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.82 / $35.56 / $86.51
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.30 / $30.30 / $30.30
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.90 / $30.30 / $36.36
Fidelis
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.61 / $20.61 / $22.42
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.99 / $38.99 / $38.99
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.97 / $29.97 / $555.00
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $22.08 / $74.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.98 / $23.98 / $41.43
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.90 / $28.90 / $30.30
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.90 / $28.90 / $30.70