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Montana 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
$1,696.14 / $12,419.60 / $12,419.60
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,203.63 / $4,203.63 / $4,203.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,017.28 / $4,519.75 / $4,519.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,017.28 / $3,675.50 / $4,519.75
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,799.90 / $4,304.52 / $4,519.75
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,017.28 / $3,392.27 / $4,523.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,455.70 / $1,610.60 / $2,464.66