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Nebraska 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
$690.07 / $690.07 / $690.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$583.45 / $690.07 / $690.07
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$951.05 / $1,046.16 / $1,056.73
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$607.01 / $1,190.30 / $1,190.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$607.01 / $1,190.30 / $1,835.47
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$312.88 / $1,184.44 / $5,063.85
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$373.41 / $539.84 / $846.93
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,186.82 / $1,190.30 / $1,499.73
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$989.71 / $1,406.72 / $2,452.19
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,087.41 / $1,187.91 / $2,207.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$391.38 / $522.77 / $729.31