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Alaska rates for HCPCS L3901

Wrist-hand-finger orthosis (WHFO), dynamic flexor hinge, reciprocal wrist extension/ flexion, finger flexion/extension, cable driven, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,880.83 / $1,880.83 / $1,880.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,107.01 / $1,107.01 / $1,107.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,107.01 / $1,519.30 / $1,619.01
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$570.59 / $570.59 / $570.59
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,885.62 / $2,085.83 / $3,293.42
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$570.59 / $570.59 / $1,107.01
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,107.01 / $1,520.61 / $1,800.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,061.19 / $2,099.44 / $2,738.42