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New Jersey 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
$667.25 / $667.25 / $667.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$667.25 / $822.18 / $1,250.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,107.01 / $1,107.01 / $1,960.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$808.12 / $1,107.01 / $1,660.99
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,790.62 / $1,803.21 / $2,567.61
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,914.07 / $1,960.01 / $1,960.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$802.52 / $977.83 / $1,799.39