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Utah 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
Facility
Modifier
Low / Median / High Price
$224.15 / $224.15 / $224.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$224.15 / $224.15 / $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 / $237.52 / $675.75
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $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
$224.15 / $259.77 / $272.36