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Iowa 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
$596.69 / $596.69 / $619.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$361.68 / $489.18 / $779.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$579.51 / $579.51 / $895.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$579.51 / $995.63 / $1,244.53
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$773.75 / $918.46 / $995.30
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$511.65 / $1,014.37 / $4,272.47
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.54 / $474.05 / $1,112.81
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$893.30 / $895.92 / $1,237.31
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$733.76 / $1,058.81 / $1,712.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$397.85 / $417.11 / $1,068.31
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$773.75 / $773.75 / $773.75
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$611.26 / $773.75 / $773.75