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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
$1,318.71 / $1,318.71 / $1,318.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.71 / $1,318.71 / $1,712.35
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,817.45 / $1,999.20 / $2,019.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,107.01 / $2,274.65 / $2,274.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,107.01 / $2,274.65 / $3,507.56
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,166.32 / $2,263.44 / $9,312.17
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$687.76 / $1,031.63 / $1,719.39
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,267.98 / $2,274.65 / $2,865.98
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,915.00 / $2,688.22 / $4,686.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$732.26 / $1,031.63 / $1,361.97