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Maryland 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
Professional
Modifier
Low / Median / High Price
$561.66 / $599.60 / $1,072.77
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$876.61 / $876.61 / $938.11
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 / $662.45 / $1,082.27
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$960.62 / $1,372.31 / $1,976.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$566.35 / $684.64 / $1,091.30
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$180.06 / $752.50 / $960.62