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North Dakota 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
$619.29 / $619.29 / $619.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$596.69 / $596.69 / $619.29
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$795.89 / $941.02 / $964.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$995.63 / $1,005.58 / $1,264.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$270.19 / $741.54 / $4,272.47
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$339.11 / $474.05 / $678.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$270.89 / $474.05 / $966.11