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Michigan 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
$802.97 / $802.97 / $802.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$666.99 / $802.97 / $802.97
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,128.11 / $4,240.02 / $7,722.48
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,335.73 / $1,406.03 / $1,898.14
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$892.00 / $913.92 / $918.86
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,124.82 / $1,124.82 / $1,124.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$907.46 / $907.46 / $907.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$907.46 / $907.46 / $1,630.13
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$802.97 / $1,016.06 / $1,016.06
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$802.97 / $1,016.06 / $1,581.43
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$490.64 / $653.74 / $993.82