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Idaho 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
$408.98 / $777.94 / $777.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$579.51 / $579.51 / $911.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$423.04 / $423.04 / $596.90
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$262.32 / $776.78 / $920.66
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$799.59 / $844.01 / $888.43
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $663.72 / $799.59
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$777.94 / $867.61 / $1,301.42
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$621.90 / $621.90 / $932.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$375.69 / $406.33 / $644.44