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Connecticut rates for HCPCS L3904

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,651.11 / $1,651.11 / $1,651.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,404.93 / $1,628.78 / $1,812.97
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,632.78 / $3,397.13 / $3,886.66
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,966.25 / $1,966.25 / $2,060.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,017.28 / $2,017.28 / $2,017.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,472.61 / $1,472.61 / $2,017.28
ConnectiCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,208.13 / $2,208.13 / $2,208.13
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,098.44 / $2,208.13 / $2,970.12
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,497.60 / $2,497.60 / $2,497.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,293.38 / $1,694.79 / $2,824.65