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New Mexico 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
$411.21 / $411.21 / $411.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$411.21 / $631.50 / $2,994.64
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,215.94 / $4,121.82 / $7,296.90
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$502.41 / $669.88 / $798.18
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 / $579.51 / $579.51
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$670.86 / $838.58 / $1,257.86
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$262.32 / $262.32 / $741.54
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$423.04 / $579.51 / $982.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$375.69 / $406.33 / $612.08