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Maryland rates for HCPCS L3915

Wrist Hand Orthosis Includes One Or More Non- Torsion Joint(S) Elastic Bands Turnblocks May Include Soft Interface Straps Prefabricated Itemthat Has Been Trimmed Bent Molded Assembled Orotherwise Customized To Fit A Specific Patient By An Individual With Expertise (Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$232.84 / $248.57 / $444.72
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.40 / $363.40 / $388.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$325.37 / $325.37 / $325.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$237.52 / $237.52 / $450.25
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.23 / $568.90 / $819.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.79 / $283.82 / $452.40
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$311.95 / $311.95 / $398.23