go back

Missouri 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
$1,082.52 / $1,082.52 / $1,442.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,082.52 / $1,121.89 / $1,712.35
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,067.86 / $2,171.25 / $9,545.24
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,037.44 / $1,079.00 / $1,672.99
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 / $1,607.20
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$961.46 / $1,673.75 / $9,312.17
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$732.26 / $1,031.63 / $2,513.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$732.26 / $1,022.43 / $1,476.17