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Utah 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
$17.53 / $17.53 / $98.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.53 / $32.68 / $163.00
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 / $36.61 / $39.03
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.57 / $39.72 / $51.83
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.65 / $53.14 / $53.14
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.26 / $38.09 / $57.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.26 / $26.90 / $32.65