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Colorado 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
$476.68 / $476.68 / $476.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.45 / $476.68 / $631.50
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.22 / $956.43 / $1,736.49
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$496.06 / $496.06 / $535.74
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
Denver HMP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$262.32 / $476.68 / $1,238.58
Denver HMP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$262.32 / $262.32 / $262.32
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$621.39 / $1,064.03 / $1,685.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$375.69 / $406.33 / $612.08