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Montana 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 / $6,202.52 / $6,202.52
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,216.67 / $2,216.67 / $2,216.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,107.01 / $2,383.37 / $2,383.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,107.01 / $1,938.19 / $2,383.37
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$987.72 / $2,269.88 / $2,383.37
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,107.01 / $1,788.83 / $2,385.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$798.83 / $883.84 / $1,352.52