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Montana 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
Professional
Modifier
Low / Median / High Price
$512.86 / $630.96 / $1,096.48
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,071.52 / $1,071.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$602.56 / $1,148.15 / $1,148.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $933.25 / $1,148.15
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.14 / $1,071.52 / $2,089.30
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,071.52 / $2,089.30
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562.34 / $1,023.29 / $1,318.26
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $870.96 / $1,148.15
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$478.63 / $602.56 / $630.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $489.78 / $549.54