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Connecticut 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
Facility
Modifier
Low / Median / High Price
$861.06 / $861.06 / $861.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$800.10 / $852.96 / $917.07
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,373.01 / $1,771.62 / $2,026.91
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,079.00 / $1,079.00 / $1,130.54
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
$808.12 / $1,107.01 / $1,609.82
ConnectiCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,151.55 / $1,151.55 / $1,151.55
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,151.55 / $1,240.13 / $1,771.62
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,226.86 / $1,226.86 / $1,226.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$674.50 / $883.84 / $1,473.07