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Connecticut rates for HCPCS L3764

Elbow-wrist-hand orthosis (EWHO), 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
$494.59 / $494.59 / $494.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.18 / $451.66 / $494.59
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$788.65 / $1,017.61 / $1,164.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$496.06 / $496.06 / $519.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$579.51 / $579.51 / $579.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$423.04 / $579.51 / $785.28
ConnectiCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$661.45 / $661.45 / $661.45
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$661.45 / $674.63 / $954.86
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$553.14 / $553.14 / $553.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$387.43 / $507.68 / $949.21