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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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$415.17 / $432.05 / $764.36
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$272.50 / $984.39 / $1,779.74
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$681.23 / $908.31 / $1,237.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$579.51 / $579.51 / $579.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$423.04 / $579.51 / $810.24
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$262.32 / $593.69 / $4,272.47
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$367.25 / $406.33 / $621.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$367.25 / $406.33 / $612.08