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Montana rates for HCPCS L3916

Wrist-hand orthosis (WHO), includes one or more nontorsion joint(s), elastic bands, turnbuckles, may include soft interface, straps, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$224.17 / $1,641.41 / $1,641.41
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.48 / $575.48 / $575.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$325.37 / $618.75 / $618.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$325.37 / $618.75 / $618.75
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.52 / $589.29 / $618.75
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$464.41 / $474.70 / $619.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$244.52 / $259.77 / $297.37