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Missouri rates for HCPCS L3999

Upper limb orthosis, not otherwise specified

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$141.50 / $141.50 / $141.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.12 / $14.40 / $422.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.38 / $28.00 / $35.17
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 / $5.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $112.62
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.06 / $120.06 / $120.06