go back

Vermont 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
$496.57 / $496.57 / $572.97
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 / $741.12 / $789.76
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$579.51 / $579.51 / $579.51
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$423.04 / $741.76 / $789.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.45 / $764.72 / $1,176.38