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Rhode Island 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
$49.41 / $62.14 / $67.06
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$159.88 / $216.00 / $255.71
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.77 / $73.84 / $102.28
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 / $87.68 / $94.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.75 / $56.42 / $94.04