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Other Upper Limb Orthosis

Washington rates for HCPCS L3999

Upper limb orthosis, not otherwise specified

Rates data updated July 2026.

Facilitymedian $1,096 · 10th–90th $1,096$1,0960%50%$1,096Professionalmedian $14 · 10th–90th $1$4270%10%20%10th90th$14$2.0$10.0$50.0$200.0$1.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$14.45
Median
$14.45
Typical High
$426.58
Cigna
Setting
Facility
Modifier
Global
Typical Low
$34.67
Median
$34.67
Typical High
$34.67
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1.17
Median
$5.25
Typical High
$5.62
Molina
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$50.12
Typical High
$85.11
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$1,096.48
Median
$1,096.48
Typical High
$1,096.48
Pacific Source
Setting
Professional
Modifier
Global
Typical Low
$1,096.48
Median
$1,096.48
Typical High
$1,096.48