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Utah rates for HCPCS L3919

Hand orthosis (HO), without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.11 / $128.82 / $147.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $169.82 / $660.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.83 / $177.83 / $177.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $128.82 / $186.21
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $218.78 / $281.84
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$223.87 / $263.03 / $457.09
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $213.80 / $309.03
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $302.00 / $309.03
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.78 / $309.03 / $354.81
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.65 / $131.83 / $173.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $131.83 / $190.55