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Michigan rates for HCPCS L3931

Wrist-hand-finger orthosis (WHFO), includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, prefabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$130.57 / $130.57 / $130.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.58 / $125.61 / $130.57
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$346.04 / $689.46 / $1,255.73
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$217.20 / $228.63 / $308.64
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$130.66 / $145.94 / $148.61
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$182.90 / $182.90 / $182.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.61 / $125.61 / $125.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.70 / $190.10 / $331.41
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$130.57 / $165.21 / $165.21
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.73 / $165.21 / $240.06
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$143.81 / $169.19 / $194.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.52 / $107.36 / $167.15