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Louisiana 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
$453.23 / $481.12 / $648.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$415.17 / $481.12 / $522.96
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$729.91 / $1,246.95 / $1,752.75
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$497.77 / $595.39 / $595.39
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
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 / $579.51 / $789.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$270.89 / $417.11 / $650.08