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New Jersey 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
$353.32 / $353.33 / $987.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$353.33 / $406.16 / $489.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$579.51 / $579.51 / $1,037.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$423.04 / $579.51 / $878.08
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$948.18 / $954.86 / $1,359.64
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,013.56 / $1,037.89 / $1,037.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$406.33 / $517.79 / $1,037.89