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Wisconsin rates for HCPCS L3999

Upper Limb Orthotic, Not Otherwise Specified

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.40 / $24.70 / $61.75
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
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.57 / $54.57 / $54.57
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.57 / $112.62 / $112.62
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.10 / $14.10 / $14.10
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $58.40 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.57 / $54.57 / $54.57
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.92 / $65.00 / $112.62
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.25 / $5.25 / $34.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.10 / $14.10 / $14.10