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Maryland 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
$1,321.32 / $1,484.29 / $2,523.71
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,731.00 / $1,731.00 / $2,206.90
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,259.87 / $3,228.39 / $4,648.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,365.05 / $1,610.60 / $2,567.29
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,934.14 / $1,934.14 / $2,259.87