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Hand Orthosis (HO), Metacarpal Fracture, Custom Fitted

Washington 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

Rates data updated July 2026.

Facilitymedian $112 · 10th–90th $76$2450%10%20%10th90th$112Professionalmedian $93 · 10th–90th $51$1950%10%10th90th$93$1.0$5.0$20.0$100.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$75.86
Median
$75.86
Typical High
$181.97
Aetna
Setting
Professional
Modifier
Global
Typical Low
$61.66
Median
$75.86
Typical High
$316.23
Asuris Northwest Health
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$109.65
Typical High
$112.20
Asuris Northwest Health
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$97.72
Typical High
$125.89
Cigna
Setting
Facility
Modifier
Global
Typical Low
$64.57
Median
$64.57
Typical High
$64.57
Cigna
Setting
Professional
Modifier
Global
Typical Low
$46.77
Median
$46.77
Typical High
$64.57
Kaiser Permanente
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$154.88
Typical High
$323.59
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$131.83
Typical High
$239.88
Molina
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$87.10
Typical High
$95.50
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$89.13
Median
$109.65
Typical High
$114.82
Pacific Source
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$112.20
Typical High
$117.49
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$165.96
Typical High
$223.87
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$93.33
Typical High
$109.65
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$109.65
Median
$109.65
Typical High
$112.20
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$97.72
Typical High
$125.89
United
Setting
Facility
Modifier
Global
Typical Low
$51.29
Median
$169.82
Typical High
$169.82
United
Setting
Professional
Modifier
Global
Typical Low
$47.86
Median
$56.23
Typical High
$100.00
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$81.28
Typical High
$173.78