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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
$660.69 / $660.69 / $660.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $912.01 / $1,698.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $1,096.48 / $1,995.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $812.83 / $1,096.48
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $2,089.30 / $2,884.03
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $1,949.84 / $1,949.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $1,148.15 / $2,041.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $977.24 / $1,548.82