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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

Facilitymedian $1,096 · 10th–90th $490–$3,4670%10%20%10th90th$1,096Professionalmedian $490 · 10th–90th $389–$8510%20%40%10th90th$490$1.0$5.0$20.0$100.0$500.0$2.0K$10.0K

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$489.78 / $489.78 / $489.78
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$389.05 / $467.74 / $660.69
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,122.02 / $2,570.40 / $4,897.79
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$851.14 / $851.14 / $912.01
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$562.34 / $562.34 / $562.34
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$575.44 / $575.44 / $575.44
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$426.58 / $776.25 / $1,000.00
Health Alliance Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$489.78 / $1,621.81 / $1,819.70
Health Alliance Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$467.74 / $691.83 / $1,122.02
Priority Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$575.44 / $575.44 / $575.44
Priority Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$457.09 / $1,000.00 / $1,000.00
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$346.74 / $707.95 / $1,096.48
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$316.23 / $407.38 / $660.69