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Maryland 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

Facilitymedian $468 · 10th–90th $309–$6170%10%20%10th90th$468Professionalmedian $457 · 10th–90th $398–$7940%20%10th90th$457$500.0$1.0K$2.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$389.05 / $446.68 / $758.58
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$602.56 / $602.56 / $691.83
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$575.44 / $575.44 / $602.56
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$426.58 / $426.58 / $575.44
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$707.95 / $1,000.00 / $1,513.56
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$275.42 / $398.11 / $630.96
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$407.38 / $489.78 / $870.96
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$489.78 / $489.78 / $851.14