go back

South 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
$18.20 / $18.20 / $18.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.85 / $21.88 / $33.11
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.55 / $25.12 / $33.88
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $38.02 / $44.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.98 / $30.20 / $67.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $21.88 / $51.29
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.44 / $23.44 / $26.30
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.62 / $31.62 / $63.10
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.48 / $11.48 / $11.48
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.70 / $25.70 / $30.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.78 / $20.89 / $48.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.45 / $18.62 / $23.99