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Vermont rates for HCPCS L3995

Addition to upper extremity orthosis, sock, fracture or equal, each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.14 / $22.91 / $28.84
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.90 / $38.90 / $38.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.20 / $30.20 / $35.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $21.88 / $30.20
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.02 / $46.77 / $47.86
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.78 / $20.89 / $22.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.22 / $28.18 / $100.00