go back

Hawaii 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
$1,099.05 / $1,099.05 / $1,099.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,971.59 / $4,971.59 / $4,971.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,017.28 / $2,017.28 / $6,884.01
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,258.19 / $6,553.08 / $6,553.08
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,754.91 / $6,258.19 / $8,761.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,464.66 / $4,971.59 / $6,884.01
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,736.92 / $5,041.21 / $5,956.64