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Indiana 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
$425.04 / $425.04 / $858.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$408.69 / $441.39 / $465.28
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$678.42 / $768.59 / $858.76
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$430.25 / $496.06 / $700.15
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$654.69 / $944.64 / $1,288.14
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$729.95 / $944.64 / $1,159.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$579.51 / $579.51 / $858.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$423.04 / $579.51 / $880.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$270.89 / $428.42 / $632.64