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Minnesota 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
$596.69 / $596.69 / $596.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$400.81 / $596.69 / $619.29
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$735.64 / $858.76 / $1,195.79
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$687.01 / $815.82 / $858.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$579.51 / $2,649.48 / $7,358.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$995.63 / $1,055.35 / $1,264.44
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,572.97 / $2,517.46 / $5,794.26
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$995.63 / $995.63 / $1,024.40
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$270.19 / $858.76 / $4,272.47
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$270.89 / $428.42 / $895.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$270.89 / $424.66 / $869.54