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Alaska rates for HCPCS L3925

Finger orthosis (FO), proximal interphalangeal (PIP)/distal interphalangeal (DIP), nontorsion joint/spring, extension/flexion, may include soft interface material, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.94 / $59.62 / $59.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.61 / $36.61 / $36.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.73 / $36.61 / $39.03
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.53 / $17.53 / $17.53
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.98 / $66.11 / $104.39
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.91 / $59.91 / $67.95
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.05 / $67.95 / $140.13
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.53 / $17.53 / $46.17
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.61 / $55.27 / $81.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.63 / $34.72 / $86.79