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Nebraska 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
$2,058.80 / $2,058.80 / $2,058.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,058.80 / $2,058.80 / $2,673.36
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,837.44 / $3,121.19 / $3,152.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,017.28 / $3,551.23 / $3,551.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,017.28 / $3,551.23 / $5,476.05
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,854.33 / $3,533.75 / $17,217.72
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,229.13 / $1,610.60 / $2,684.34
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,540.83 / $3,551.23 / $4,904.42
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,215.36 / $4,243.99 / $7,316.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,229.13 / $1,610.60 / $2,426.16