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Montana 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
Professional
Modifier
Low / Median / High Price
$44.57 / $68.34 / $326.32
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.33 / $114.33 / $114.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.66 / $122.92 / $122.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.66 / $99.97 / $122.92
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.68 / $117.07 / $122.92
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.66 / $92.26 / $123.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.66 / $51.62 / $78.98