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Wisconsin 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
$22.71 / $22.71 / $54.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.91 / $22.71 / $34.01
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.02 / $49.52 / $81.94
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.87 / $41.87 / $55.37
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.39 / $96.34 / $96.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.97 / $92.87 / $187.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $74.98 / $85.20
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.61 / $34.07 / $51.77
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.78 / $42.01 / $54.02
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.10 / $45.02 / $196.70
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.82 / $22.46 / $49.02
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.49 / $55.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.61 / $34.07 / $51.77
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.78 / $42.01 / $54.02
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.02 / $68.64 / $108.40
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.97 / $87.92 / $196.70
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $29.97 / $232.65
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.02 / $45.02 / $45.02
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.96 / $45.02 / $45.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.99 / $22.46 / $45.02