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Arkansas 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
$466.11 / $466.11 / $466.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$361.68 / $466.11 / $466.11
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$219,999.78 / $539,999.46 / $949,999.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$723.93 / $958.15 / $1,064.60
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$872.92 / $872.92 / $980.56
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$980.56 / $980.56 / $980.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$579.51 / $579.51 / $670.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$423.04 / $579.51 / $655.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$270.89 / $406.33 / $670.86