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Idaho rates for HCPCS L3901

Wrist Hand Finger Orthosis Dynamic Flexor Hinge Reciprocal Wrist Extension/ Flexion Finger Flexion/Extension Cable Driven Custom-Fabricated

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$847.07 / $1,738.01 / $1,738.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,107.01 / $1,107.01 / $1,348.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$808.12 / $1,107.01 / $1,140.22
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$570.59 / $1,498.17 / $2,149.73
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,786.37 / $1,885.62 / $1,984.86
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $1,482.83 / $1,786.37
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,738.01 / $1,938.34 / $2,907.51
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,389.40 / $1,448.95 / $2,084.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$817.18 / $883.84 / $1,401.77