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Arizona rates for HCPCS L3999

Upper limb orthosis, not otherwise specified

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.40 / $14.40 / $422.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.00 / $43.35 / $78.38
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $40.00 / $54.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.25 / $5.25 / $5.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $112.62