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Utah 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
$11.61 / $11.61 / $11.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.61 / $20.99 / $121.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.97 / $29.97 / $29.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.39 / $21.88 / $52.13
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.58 / $26.41 / $35.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.57 / $35.20 / $35.20
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.05 / $25.24 / $37.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.08 / $17.98 / $21.12