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Missouri 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
$1,690.06 / $1,690.06 / $2,251.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,690.06 / $1,751.51 / $2,673.36
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,228.39 / $3,389.81 / $14,902.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,805.58 / $1,966.25 / $2,612.87
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 / $2,077.80
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,690.06 / $2,601.82 / $17,217.72
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,334.39 / $1,610.60 / $3,924.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,240.95 / $1,610.60 / $2,464.66