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Florida 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
$361.68 / $400.81 / $459.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$361.68 / $459.21 / $764.36
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 / $423.04 / $768.00
Florida Blue
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.44 / $560.13 / $1,000.23
Florida Blue
Facility/Professional
Professional
Modifier
Low / Median / High Price
$523.75 / $872.92 / $1,000.22
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.92 / $309.12 / $340.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$367.25 / $435.49 / $612.08
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.12 / $309.12 / $487.95