go back

Louisiana 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
$62.92 / $66.79 / $89.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.31 / $66.79 / $72.59
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$101.33 / $173.11 / $243.33
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.11 / $82.66 / $82.66
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
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 / $92.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.42 / $53.70 / $79.55