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Massachusetts 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
$1,484.29 / $1,484.29 / $1,484.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,484.29 / $1,554.79 / $2,028.07
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,774.67 / $5,879.48 / $20,446.47
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,462.42 / $2,481.90 / $3,317.51
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,605.69 / $4,386.74 / $5,649.29
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,224.46 / $2,618.90 / $2,618.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,964.96 / $2,017.28 / $2,381.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,472.61 / $2,017.28 / $4,290.75
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,750.51 / $2,750.51 / $2,888.04
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,497.60 / $2,497.60 / $2,497.60
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,135.65 / $20,446.47 / $20,446.47
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,293.38 / $1,694.79 / $3,317.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,342.17 / $1,815.89 / $3,228.39