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Rhode Island 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
Professional
Modifier
Low / Median / High Price
$444.62 / $489.18 / $603.53
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,438.76 / $1,943.23 / $2,300.55
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$534.77 / $534.77 / $894.38
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 / $748.16 / $810.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$344.38 / $581.15 / $846.13