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Utah rates for HCPCS L3904

Wrist-hand-finger orthosis (WHFO), external powered, electric, custom fabricated

Facilitymedian $1,995 · 10th–90th $1,047–$4,2660%20%40%10th90th$1,995Professionalmedian $2,570 · 10th–90th $1,047–$18,6210%10%10th90th$2,570$50.0$200.0$1.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,047.13 / $1,047.13 / $1,047.13
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,047.13 / $2,398.83 / $18,620.87
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,995.26 / $1,995.26 / $1,995.26
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,479.11 / $1,479.11 / $2,089.30
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $3,162.28 / $4,073.80
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,073.80 / $4,265.80 / $4,265.80
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,398.83 / $3,090.30 / $3,801.89
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,311.31 / $4,265.80 / $4,365.16
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,090.30 / $4,365.16 / $4,365.16
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,348.96 / $1,621.81 / $2,951.21
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,258.93 / $1,621.81 / $3,162.28