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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

Facilitymedian $871 · 10th–90th $427–$1,0960%20%40%10th90th$871Professionalmedian $457 · 10th–90th $398–$7410%50%10th90th$457$1.0$5.0$20.0$100.0$500.0$2.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$426.58 / $426.58 / $426.58
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$398.11 / $446.68 / $676.08
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$501.19 / $870.96 / $1,096.48
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$478.63 / $501.19 / $891.25
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$870.96 / $1,122.02 / $1,318.26
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$575.44 / $575.44 / $870.96
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$426.58 / $426.58 / $758.58
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$316.23 / $537.03 / $707.95
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$269.15 / $426.58 / $707.95