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South Carolina 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
$541.14 / $541.14 / $541.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$491.89 / $541.14 / $957.36
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$600.00 / $765.34 / $1,159.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$607.01 / $607.01 / $670.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$443.12 / $701.00 / $865.03
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$415.10 / $797.64 / $1,717.07
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$800.03 / $800.03 / $800.03
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$738.79 / $738.79 / $738.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.63 / $519.04 / $657.47