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Montana 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
Professional
Modifier
Low / Median / High Price
$101.11 / $120.73 / $740.36
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$207.90 / $207.90 / $207.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.61 / $223.53 / $223.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.61 / $223.53 / $223.53
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$115.10 / $212.89 / $223.53
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$167.77 / $171.49 / $225.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.64 / $100.29 / $153.46