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Minnesota rates for HCPCS L3999

Upper limb orthosis, not otherwise specified

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.02 / $31.02 / $31.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.30 / $4.71 / $14.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.92 / $34.92 / $34.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.25 / $5.25 / $34.92
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.65 / $47.22 / $100.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.95 / $150.00 / $281.39