go back

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
$599.60 / $599.60 / $599.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$599.60 / $649.08 / $878.94
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,227.82 / $3,909.22 / $6,547.41
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$568.97 / $1,019.43 / $1,340.15
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,498.42 / $1,772.09 / $2,282.12
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$898.60 / $1,057.94 / $1,057.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$907.46 / $907.46 / $907.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$662.45 / $907.46 / $1,630.13
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,111.10 / $1,111.10 / $1,166.67
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,044.91 / $1,044.91 / $1,044.91
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,854.24 / $6,547.41 / $6,547.41
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$522.19 / $684.64 / $1,340.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$566.35 / $733.55 / $1,340.15