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Missouri 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
$426.38 / $441.88 / $891.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.38 / $441.88 / $674.45
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$814.47 / $855.19 / $3,759.59
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.21 / $496.06 / $671.13
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 / $784.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$426.38 / $741.54 / $4,272.47
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$336.64 / $406.33 / $996.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$313.08 / $406.33 / $836.96