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Louisiana 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
$957.50 / $1,016.42 / $1,369.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$876.23 / $1,016.42 / $1,174.36
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,542.01 / $2,634.29 / $3,702.86
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,051.59 / $1,257.84 / $1,257.84
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
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 / $1,619.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$589.23 / $841.06 / $1,361.97