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Michigan 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
$66.13 / $66.13 / $66.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.97 / $66.13 / $68.34
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$175.26 / $349.18 / $635.96
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.00 / $115.79 / $156.32
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$73.52 / $75.26 / $75.70
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.63 / $92.63 / $92.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.66 / $64.66 / $64.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.89 / $64.66 / $134.25
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.13 / $83.68 / $83.68
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.19 / $83.68 / $121.57
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.82 / $85.68 / $98.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.02 / $54.38 / $82.88