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Oregon 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
Professional
Modifier
Low / Median / High Price
$52.40 / $67.84 / $326.32
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 / $47.20 / $64.66
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.18 / $219.45 / $286.24
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.84 / $92.95 / $113.11
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.08 / $106.32 / $118.77
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.76 / $113.11 / $124.42
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.80 / $113.11 / $124.42
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.66 / $97.03 / $118.77
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.20 / $99.04 / $124.42
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$94.23 / $188.08 / $396.81
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.27 / $124.42 / $124.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.59 / $51.62 / $98.95