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Illinois 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
Facility
Modifier
Low / Median / High Price
$37.02 / $52.79 / $75.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.97 / $37.02 / $59.91
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.23 / $61.23 / $61.23
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.86 / $145.26 / $619.75
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.17 / $54.74 / $54.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.61 / $36.61 / $77.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.73 / $36.61 / $83.63
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.23 / $79.23 / $104.44
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.64 / $93.64 / $93.64
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.00 / $47.15 / $49.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.63 / $35.61 / $63.10