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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
$85.45 / $130.11 / $149.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.45 / $159.34 / $836.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$176.58 / $176.58 / $176.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.90 / $176.58 / $244.34
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.89 / $219.18 / $284.93
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$262.89 / $293.20 / $293.20
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.96 / $210.17 / $315.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.64 / $131.18 / $159.18