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Arizona 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
$1,479.11 / $1,949.84 / $6,760.83
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.02 / $2,630.27 / $5,495.41
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,311.31 / $4,365.16 / $8,317.64
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 / $1,995.26
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $2,884.03 / $17,378.01
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,621.81 / $25,703.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,202.26 / $2,137.96 / $3,467.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $1,621.81 / $2,398.83