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Alaska rates for HCPCS L3917

Hand orthosis (HO), metacarpal fracture orthosis, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.11 / $96.89 / $96.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.66 / $64.66 / $64.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.66 / $86.85 / $92.55
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.32 / $33.32 / $33.32
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.45 / $107.45 / $169.67
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.32 / $33.32 / $64.66
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.66 / $86.93 / $102.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.66 / $108.15 / $282.12