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Idaho rates for HCPCS L3906

Wrist-hand orthosis (WHO), without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$249.84 / $249.84 / $249.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$228.86 / $308.31 / $400.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$293.31 / $293.31 / $364.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$214.12 / $214.12 / $473.37
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.30 / $343.00 / $456.86
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$411.17 / $434.02 / $456.86
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $337.15 / $401.54
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$400.04 / $446.15 / $669.23
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$319.80 / $319.80 / $479.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$197.33 / $217.32 / $344.67