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Utah 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
Facility
Modifier
Low / Median / High Price
$570.59 / $570.59 / $570.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$570.59 / $734.13 / $6,202.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,107.01 / $1,107.01 / $1,107.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$808.12 / $1,107.01 / $1,660.99
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,027.38 / $1,657.07 / $2,154.19
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,987.59 / $2,216.67 / $2,216.67
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,262.26 / $1,588.92 / $2,383.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$692.04 / $883.84 / $1,038.06