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Mississippi 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
$489.19 / $489.19 / $779.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$459.21 / $557.98 / $779.65
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.46 / $676.46 / $676.46
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.46 / $676.46 / $676.46
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 / $423.04 / $579.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$270.89 / $426.41 / $689.53