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Michigan 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
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$332.87 / $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
$237.52 / $484.66 / $844.69
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.20 / $112.20 / $332.88
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $332.88 / $582.88
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$366.63 / $431.33 / $496.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$216.48 / $273.73 / $456.21