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Utah 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
$141.25 / $234.42 / $234.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $275.42 / $1,318.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$295.12 / $295.12 / $295.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $213.80 / $524.81
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $331.13 / $426.58
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$338.84 / $398.11 / $676.08
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $323.59 / $478.63
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $446.68 / $467.74
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $457.09 / $562.34
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$181.97 / $218.78 / $288.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $218.78 / $309.03