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Massachusetts 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
$49.41 / $49.41 / $49.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.41 / $53.48 / $72.38
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$88.28 / $322.20 / $539.41
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.87 / $83.98 / $110.46
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.03 / $76.48 / $76.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.66 / $64.66 / $83.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.20 / $64.66 / $119.12
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.57 / $91.57 / $96.15
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.59 / $65.59 / $65.59
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$235.05 / $539.41 / $539.41
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.02 / $56.42 / $110.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.75 / $60.43 / $110.46