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Utah 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
$1,039.78 / $1,039.78 / $1,039.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,039.78 / $1,441.71 / $12,419.60
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 / $2,017.28 / $2,316.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,948.29 / $3,142.41 / $4,085.13
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,769.19 / $4,203.63 / $4,203.63
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,393.69 / $3,013.16 / $4,519.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,237.43 / $1,596.24 / $1,937.03