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Nebraska 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
$18.20 / $18.20 / $43.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $50.12 / $162.18
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $67.61 / $69.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.31 / $36.31 / $79.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.31 / $83.18 / $117.49
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.81 / $75.86 / $288.40
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.91 / $33.11 / $70.79
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $77.62 / $173.78
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.43 / $79.43 / $79.43
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $173.78 / $173.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.89 / $31.62 / $63.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.44 / $32.36 / $52.48