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Pennsylvania rates for HCPCS L3925

Finger Orthosis Proximal Interphalangeal (Pip)/Distal Interphalangeal (Dip) Non Torsion Joint/Spring Extension/Flexion May Include Soft Interface Material Prefabricated Off-The-Shelf (Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.80 / $72.80 / $88.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.30 / $32.67 / $65.11
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.18 / $55.40 / $55.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.61 / $36.61 / $54.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.73 / $26.73 / $47.65
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.07 / $54.42 / $103.40
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.89 / $115.67 / $125.00
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.40 / $37.40 / $58.17
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.48 / $82.31 / $88.24
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.67 / $32.67 / $100.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.50 / $25.60 / $107.20
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.61 / $36.61 / $54.42
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.73 / $26.73 / $83.63
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.86 / $52.73 / $52.73
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.86 / $52.73 / $68.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.47 / $28.16 / $49.96