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Minnesota 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
$2,571.69 / $2,571.69 / $2,571.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,651.11 / $2,571.69 / $3,131.74
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,189.94 / $3,950.55 / $5,204.04
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,960.97 / $3,516.15 / $3,701.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,017.28 / $11,420.40 / $31,719.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,290.75 / $4,548.20 / $5,449.25
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,780.15 / $10,957.31 / $24,975.74
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,290.75 / $4,290.75 / $4,415.60
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,070.97 / $3,701.21 / $17,217.72
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,073.74 / $1,788.09 / $3,759.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,073.74 / $1,801.19 / $4,811.57