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Massachusetts 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
$444.62 / $444.62 / $444.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$444.62 / $444.62 / $572.97
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$910.47 / $2,898.80 / $4,930.17
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$397.85 / $785.60 / $993.76
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,111.11 / $1,314.05 / $1,692.25
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$763.96 / $784.50 / $784.50
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 / $995.63
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$823.92 / $823.92 / $865.12
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$553.14 / $553.14 / $553.14
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,743.28 / $4,930.17 / $4,930.17
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.61 / $507.68 / $993.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$365.52 / $507.68 / $993.76