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Indiana rates for HCPCS L3905

Wrist-hand orthosis (WHO), includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$537.03 / $537.03 / $2,187.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $562.34 / $758.58
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $1,096.48 / $1,380.38
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $630.96 / $1,096.48
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $1,380.38 / $1,621.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $602.56 / $1,096.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $446.68 / $954.99
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$371.54 / $741.31 / $870.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $512.86 / $724.44