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Pennsylvania 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
$16.18 / $23.50 / $23.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.18 / $18.94 / $24.18
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.94 / $39.32 / $39.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.97 / $29.97 / $48.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $21.88 / $52.13
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.22 / $48.06 / $91.31
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.00 / $51.00 / $145.43
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.55 / $27.04 / $29.49
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.18 / $23.50 / $62.62
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.95 / $18.94 / $27.07
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.20 / $22.60 / $94.70
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.97 / $29.97 / $48.06
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $21.88 / $52.13
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.18 / $27.18 / $37.43
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.18 / $37.43 / $45.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.08 / $20.79 / $43.25