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Missouri 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
$53.70 / $562.34 / $645.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $588.84 / $1,288.25
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $1,096.48 / $3,890.45
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $630.96 / $1,023.29
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $660.69 / $1,096.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$602.56 / $602.56 / $602.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $446.68 / $602.56
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$537.03 / $870.96 / $5,011.87
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $537.03 / $5,495.41
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $870.96 / $1,047.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $512.86 / $776.25