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Utah 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
$167.71 / $167.71 / $167.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$167.71 / $194.28 / $1,641.41
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 / $325.37 / $479.81
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$266.72 / $430.20 / $559.26
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$516.01 / $575.48 / $575.48
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$327.71 / $412.50 / $618.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.58 / $259.77 / $320.24