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Maine rates for HCPCS L3766

Elbow-wrist-hand-finger orthosis (EWHFO), includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $851.14 / $2,238.72
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,445.44 / $1,737.80 / $1,949.84
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $812.83 / $1,047.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $831.76 / $831.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $602.56 / $831.76
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,258.93 / $1,513.56
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $891.25 / $2,238.72
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$426.58 / $660.69 / $660.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $812.83 / $1,412.54