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New Mexico 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
$693.12 / $693.12 / $693.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$693.12 / $1,064.43 / $3,959.48
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$846.86 / $1,129.14 / $1,345.39
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 / $907.46
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,130.80 / $1,413.50 / $2,120.25
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$404.54 / $404.54 / $1,062.26
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$662.45 / $907.46 / $1,608.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$568.97 / $626.62 / $943.92