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Alaska rates for HCPCS L3904

Wrist-hand-finger orthosis (WHFO), external powered, electric, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $1,949.84 / $5,011.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $1,995.26 / $1,995.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $1,479.11 / $2,089.30
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $3,162.28 / $5,623.41
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,162.28 / $5,623.41 / $9,772.37
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,818.38 / $5,754.40 / $6,025.60
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,677.35 / $5,754.40 / $5,888.44
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $1,047.13 / $4,466.84
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $1,995.26 / $3,090.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,584.89 / $1,584.89 / $2,089.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398.83 / $4,365.16 / $14,454.40