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Alabama 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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$787.29 / $787.29 / $787.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$372.69 / $787.29 / $787.29
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$649.71 / $649.71 / $649.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$579.51 / $579.51 / $858.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$423.04 / $579.51 / $830.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$270.89 / $435.49 / $650.14