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New Jersey 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
$38.49 / $38.49 / $38.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.49 / $49.21 / $67.28
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.66 / $64.66 / $113.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.20 / $64.66 / $94.95
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.32 / $104.06 / $148.16
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.46 / $113.11 / $113.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.87 / $56.42 / $103.83