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Alaska rates for HCPCS L3764

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

Facilitymedian $490 · 10th–90th $263–$1,0230%20%40%10th90th$490Professionalmedian $603 · 10th–90th $427–$1,4450%20%10th90th$603$100.0$200.0$500.0$1.0K$2.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$426.58 / $489.78 / $891.25
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$575.44 / $575.44 / $575.44
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$426.58 / $426.58 / $1,202.26
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$263.03 / $776.25 / $1,000.00
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$489.78 / $1,000.00 / $2,691.53
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$776.25 / $1,023.29 / $1,071.52
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$831.76 / $1,023.29 / $1,071.52
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$263.03 / $263.03 / $1,047.13
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $575.44 / $851.14
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$398.11 / $398.11 / $537.03
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$436.52 / $776.25 / $2,570.40