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Ohio 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
$23.99 / $28.18 / $42.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.85 / $21.88 / $30.90
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.88 / $46.77 / $69.18
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.71 / $48.98 / $97.72
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $26.30 / $58.88
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.05 / $28.18 / $45.71
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.55 / $33.88 / $51.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $21.88 / $30.20
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.20 / $30.20 / $52.48
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $21.88 / $30.20
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.50 / $27.54 / $39.81
SummaCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $54.95 / $54.95
SummaCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.71 / $51.29 / $95.50
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.14 / $19.95 / $41.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.80 / $20.42 / $28.84