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Idaho 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
$1,696.14 / $2,826.89 / $2,826.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,017.28 / $2,017.28 / $2,699.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,472.61 / $2,017.28 / $2,077.80
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,039.78 / $2,274.09 / $3,228.39
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,905.55 / $3,066.97 / $3,228.39
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $2,411.83 / $2,905.55
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,826.89 / $3,152.72 / $4,729.08
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,259.87 / $2,356.71 / $3,389.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,489.14 / $1,610.60 / $2,481.90