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Maine rates for HCPCS L3905

Wrist-hand orthosis (WHO), includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$303.57 / $303.57 / $303.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$507.34 / $644.23 / $644.23
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$944.00 / $1,223.04 / $2,267.13
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$619.99 / $619.99 / $635.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$607.01 / $607.01 / $607.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$443.12 / $607.01 / $860.13
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$859.34 / $859.34 / $859.34
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$303.57 / $303.57 / $303.57
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$583.45 / $644.23 / $644.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$353.00 / $529.51 / $1,217.71