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Utah 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
$33.32 / $33.32 / $33.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.32 / $51.99 / $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 / $64.66 / $94.95
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.18 / $85.46 / $111.09
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.51 / $114.33 / $114.33
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.09 / $81.95 / $122.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.42 / $51.62 / $84.83