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Utah 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
$312.88 / $312.88 / $312.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$312.88 / $488.19 / $3,062.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$607.01 / $607.01 / $607.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$443.12 / $607.01 / $887.47
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$497.59 / $802.57 / $1,043.34
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$962.64 / $1,073.59 / $1,073.59
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$611.34 / $769.56 / $1,154.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$372.35 / $484.64 / $796.04