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Nebraska 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
$73.48 / $73.48 / $73.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.14 / $73.48 / $73.48
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.27 / $111.39 / $112.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.66 / $126.74 / $126.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.66 / $126.74 / $195.43
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.02 / $126.12 / $539.41
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.78 / $57.48 / $95.80
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$126.37 / $126.74 / $159.69
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.38 / $149.79 / $261.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.67 / $57.48 / $77.88