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Montana 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
$387.13 / $387.13 / $836.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$261.62 / $287.79 / $1,335.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$440.26 / $440.26 / $440.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$293.31 / $473.37 / $473.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$293.31 / $473.37 / $473.37
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$242.86 / $450.83 / $473.37
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$355.28 / $363.16 / $500.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$196.42 / $217.32 / $248.77