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Montana 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
$32.67 / $32.67 / $160.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.14 / $53.14 / $53.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.61 / $57.14 / $57.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.61 / $46.47 / $57.14
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.16 / $54.42 / $57.14
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.61 / $42.89 / $62.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.53 / $27.15 / $41.54