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Pennsylvania rates for HCPCS L3999

Upper limb orthosis, not otherwise specified

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.84 / $49.84 / $49.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.40 / $14.40 / $422.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64,999.35 / $64,999.35 / $64,999.35
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
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.36 / $201.04 / $3,522.64
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.00 / $20.00 / $60.00
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.84 / $49.84 / $49.84
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.40 / $259.35 / $547.16
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.92 / $34.92 / $34.92
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.25 / $5.25 / $5.25