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Michigan 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
$1,329.48 / $1,329.48 / $1,329.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$861.06 / $1,329.48 / $1,329.48
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,523.53 / $7,020.23 / $12,786.14
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,211.57 / $2,327.96 / $3,142.76
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,151.92 / $1,255.22 / $1,513.18
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.38 / $1,862.38 / $1,862.38
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 / $1,107.01 / $2,698.88
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,329.48 / $1,682.30 / $1,682.30
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,329.48 / $1,682.30 / $2,618.37
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $770.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$736.54 / $1,073.81 / $1,548.53