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Missouri 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
$303.64 / $303.64 / $408.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$299.58 / $314.69 / $480.32
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$580.03 / $609.03 / $2,677.42
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$298.32 / $325.80 / $487.30
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 / $237.52 / $237.52
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.42 / $453.98 / $2,714.31
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$216.48 / $289.37 / $705.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$216.48 / $289.37 / $582.88