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Maine 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
Professional
Modifier
Low / Median / High Price
$444.62 / $617.66 / $617.66
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$905.06 / $1,172.58 / $2,173.61
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$496.06 / $519.75 / $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
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$823.92 / $823.92 / $823.92
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$572.97 / $617.66 / $617.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.45 / $507.68 / $1,167.50