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Nebraska rates for HCPCS L3921

Hand-finger orthosis (HFO), includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$223.50 / $223.50 / $223.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.50 / $223.50 / $290.20
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$308.02 / $338.82 / $342.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$212.98 / $385.51 / $385.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.98 / $385.51 / $594.48
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$176.46 / $383.62 / $1,640.11
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.94 / $174.85 / $274.31
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$384.39 / $385.51 / $485.74
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$344.00 / $455.60 / $794.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.76 / $174.85 / $274.31