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Missouri 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
$31.87 / $31.87 / $48.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.67 / $38.01 / $65.11
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.39 / $47.39 / $47.39
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.06 / $73.56 / $323.39
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.86 / $32.60 / $56.69
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 / $26.73 / $39.03
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.16 / $54.36 / $286.64
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.30 / $34.95 / $84.15
Qualchoice
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.50 / $54.50 / $54.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.30 / $33.49 / $51.82