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Kansas rates for HCPCS L3917

Hand Orthosis Metacarpal Fracture Orthosis Pre- Fabricated Item That Has Been Trimmed Bent Moldemolded Assembled Or Otherwise Customized To Fit A Specific Patient By An Individual With Expertise(Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.41 / $95.41 / $95.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.32 / $62.51 / $95.41
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.51 / $91.11 / $96.63
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.43 / $90.43 / $90.43
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.66 / $64.66 / $64.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.20 / $64.66 / $167.81
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.32 / $92.87 / $539.41
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.42 / $57.48 / $147.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.42 / $55.69 / $77.00