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Michigan 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
Facility
Modifier
Low / Median / High Price
$332.88 / $332.88 / $332.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$276.50 / $332.88 / $332.88
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$882.23 / $1,757.73 / $3,201.41
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$553.74 / $582.88 / $786.89
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$369.79 / $378.87 / $380.94
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$466.30 / $466.30 / $466.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$325.37 / $325.37 / $325.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$294.52 / $325.37 / $675.75
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$332.88 / $421.22 / $421.22
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$326.67 / $421.22 / $612.02
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$366.63 / $431.33 / $496.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$203.40 / $273.73 / $417.19