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Nebraska 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
$1,318.26 / $1,318.26 / $1,318.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,318.26 / $9,332.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $1,995.26 / $2,041.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $1,096.48 / $2,344.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $2,691.53 / $3,548.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,318.26 / $2,290.87 / $9,332.54
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $1,023.29 / $2,089.30
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,290.87 / $2,290.87 / $5,128.61
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.23 / $2,344.23 / $2,344.23
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,884.03 / $5,128.61 / $5,128.61
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.08 / $1,023.29 / $2,041.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $1,023.29 / $1,548.82