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Arizona 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 $871 · 10th–90th $275–$1,9950%10%10th90th$871Professionalmedian $468 · 10th–90th $372–$9120%20%40%10th90th$468$1.0$5.0$20.0$100.0$500.0$2.0K

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
$371.54 / $467.74 / $776.25
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$275.42 / $1,122.02 / $2,137.96
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$794.33 / $1,023.29 / $1,995.26
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 / $575.44
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$263.03 / $660.69 / $4,265.80
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$363.08 / $407.38 / $5,011.87
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$316.23 / $851.14 / $851.14
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$338.84 / $407.38 / $616.60