go back

Maine rates for HCPCS L3933

Finger orthosis (FO), without joints, may include soft interface, custom fabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$143.38 / $143.38 / $440.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.16 / $138.09 / $138.59
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$203.07 / $263.08 / $487.69
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.31 / $133.38 / $133.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$130.59 / $130.59 / $130.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.33 / $130.59 / $189.77
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$184.87 / $184.87 / $184.87
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$143.38 / $143.38 / $440.29
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.54 / $138.59 / $166.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.94 / $113.91 / $261.97