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Vermont 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
$1,657.76 / $1,657.76 / $1,912.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,017.28 / $2,017.28 / $2,496.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,472.61 / $2,017.28 / $2,077.80
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,017.28 / $2,017.28 / $2,496.85
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,472.61 / $2,017.28 / $2,077.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,462.42 / $2,706.74 / $2,824.65