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Missouri 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
$60.32 / $60.32 / $80.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.51 / $62.51 / $95.41
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$115.22 / $120.98 / $531.86
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.27 / $62.92 / $93.25
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 / $91.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.68 / $93.26 / $539.41
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.77 / $57.48 / $140.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.02 / $57.48 / $115.79