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Vermont 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
Professional
Modifier
Low / Median / High Price
$864.53 / $864.53 / $997.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,107.01 / $1,107.01 / $1,302.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$808.12 / $1,499.62 / $1,619.01
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,107.01 / $1,107.01 / $1,302.13
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,103.14 / $1,519.30 / $1,619.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$589.23 / $1,049.45 / $2,048.08