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Washington 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
$27.01 / $61.31 / $102.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.19 / $24.90 / $42.82
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.04 / $91.39 / $196.70
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.28 / $34.25 / $232.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.97 / $29.97 / $29.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $21.88 / $29.97
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.75 / $40.02 / $103.12
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.77 / $40.02 / $76.95
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.61 / $30.68 / $33.74
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.76 / $36.04 / $40.02
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.02 / $40.02 / $40.02
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.04 / $44.94 / $78.16
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.22 / $33.22 / $42.33
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.09 / $39.08 / $39.08
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.79 / $34.02 / $44.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.63 / $18.02 / $34.31
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.49 / $34.02