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South Carolina 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
$1,945.72 / $1,945.72 / $1,945.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,768.63 / $1,945.72 / $3,442.28
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,275.00 / $2,868.18 / $4,167.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,750.80 / $2,017.28 / $2,227.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,472.61 / $2,017.28 / $2,364.04
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,596.24 / $2,816.00 / $6,173.90
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,210.00 / $2,210.00 / $2,375.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,656.42 / $2,656.42 / $2,656.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,307.48 / $1,788.09 / $2,363.44