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Illinois 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
Facility
Modifier
Low / Median / High Price
$59.51 / $59.51 / $65.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.55 / $60.32 / $84.87
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.33 / $234.03 / $996.25
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.63 / $88.00 / $88.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.66 / $64.66 / $126.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.20 / $75.00 / $102.90
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.63 / $121.58 / $150.53
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.53 / $150.53 / $150.53
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.37 / $93.39 / $98.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.02 / $57.48 / $99.17