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Michigan 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
$490.43 / $490.43 / $898.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$459.21 / $490.43 / $494.59
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,299.79 / $2,589.67 / $4,716.64
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$815.82 / $858.76 / $1,159.33
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$558.19 / $567.40 / $637.36
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$687.01 / $687.01 / $687.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$579.51 / $579.51 / $579.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$579.51 / $579.51 / $995.63
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$490.43 / $620.58 / $898.91
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$490.43 / $620.58 / $987.57
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.61 / $406.33 / $621.79