go back

Maine 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
$1,498.25 / $2,061.98 / $2,061.98
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,021.41 / $3,914.51 / $7,256.27
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,966.25 / $2,060.17 / $2,060.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,017.28 / $2,017.28 / $2,496.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,472.61 / $1,472.61 / $2,017.28
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,750.51 / $2,750.51 / $2,750.51
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,912.80 / $2,061.98 / $2,061.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,240.95 / $1,961.22 / $3,897.48