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Maine rates for HCPCS L3906

Wrist-hand orthosis (WHO), without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.82 / $676.08 / $1,000.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $275.42 / $616.60
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$512.86 / $616.60 / $707.95
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $269.15 / $346.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$295.12 / $295.12 / $380.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $213.80 / $295.12
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $457.09 / $537.03
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.82 / $676.08 / $1,000.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $316.23 / $794.33
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.04 / $213.80 / $288.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $269.15 / $478.63