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Massachusetts rates for HCPCS L3765

Elbow-wrist-hand-finger orthosis (EWHFO), rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$602.56 / $602.56 / $602.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $691.83 / $1,288.25
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,318.26 / $1,348.96 / $6,606.93
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $1,047.13 / $1,412.54
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,548.82 / $1,778.28 / $2,344.23
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,047.13 / $1,047.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$912.01 / $912.01 / $912.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $660.69 / $912.01
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $4,897.79 / $9,772.37
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,202.26 / $1,819.70
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,047.13 / $1,047.13
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,318.26 / $1,348.96 / $6,606.93
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $1,071.52 / $1,548.82
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $741.31 / $1,698.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $794.33 / $1,202.26