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Georgia 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
$414.54 / $414.54 / $984.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$414.54 / $523.63 / $700.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$872.92 / $1,222.08 / $3,203.62
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$496.06 / $773.50 / $1,393.57
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$729.95 / $833.48 / $1,614.90
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.98 / $741.98 / $741.98
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 / $596.90 / $878.08
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$663.42 / $872.92 / $1,314.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,079.21 / $1,513.65 / $1,647.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$290.33 / $435.49 / $852.46