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Vermont 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
$669.68 / $669.68 / $772.70
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 / $1,054.94 / $1,124.17
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$907.46 / $907.46 / $907.46
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$662.45 / $1,055.84 / $1,124.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$456.42 / $812.91 / $1,586.46