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Maine 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
$822.18 / $1,075.33 / $1,075.33
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,575.68 / $2,041.44 / $3,784.18
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,079.00 / $1,130.54 / $1,130.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,107.01 / $1,107.01 / $1,302.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$808.12 / $1,107.01 / $1,609.82
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,434.41 / $1,434.41 / $1,434.41
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$997.54 / $1,075.33 / $1,075.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$589.23 / $953.38 / $2,032.57