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Pennsylvania 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
$46.55 / $46.55 / $180.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.26 / $54.47 / $68.34
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.13 / $113.11 / $113.11
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 / $47.20 / $99.04
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.06 / $113.11 / $214.91
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.36 / $76.36 / $84.83
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.55 / $46.55 / $180.15
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.26 / $54.47 / $71.31
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.79 / $49.60 / $222.80
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.66 / $64.66 / $113.11
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.20 / $47.20 / $134.25
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.84 / $107.66 / $107.66
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.84 / $107.66 / $110.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.02 / $56.64 / $101.96