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Nationwide rates for HCPCS L3916

Wrist Hand Orthosis Includes One Or More Non- Torsion Joint(S) Elastic Bands Turnbluckes May Include Soft Interface Straps Prefabricated Offthe Shelf (Code Was Deleted 01/01/08 And Reinstated 01/01/14) Wrist Hand Finger Orthosis Wrist Extension Cock-Up With Outrigger Prefabricated Includes Fitting And Adjustment

Insurance Carrier	Facility/Professional	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $294.04 / $299.58 / $369.90	Facility	$294.04	$299.58	$369.90
Aetna Facility/Professional Professional Modifier Low / Median / High Price $248.62 / $313.07 / $428.74	Professional	$248.62	$313.07	$428.74
BCBS Facility/Professional Facility Modifier Low / Median / High Price $568.90 / $609.03 / $1,137.80	Facility	$568.90	$609.03	$1,137.80
BCBS Facility/Professional Professional Modifier Low / Median / High Price $325.80 / $325.80 / $472.99	Professional	$325.80	$325.80	$472.99
Cigna Facility/Professional Facility Modifier Low / Median / High Price $325.37 / $325.37 / $325.37	Facility	$325.37	$325.37	$325.37
Cigna Facility/Professional Professional Modifier Low / Median / High Price $237.52 / $237.52 / $618.75	Professional	$237.52	$237.52	$618.75
United Facility/Professional Professional Modifier Low / Median / High Price $222.23 / $288.39 / $462.94	Professional	$222.23	$288.39	$462.94

Nationwide rates for HCPCS L3916

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