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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
$426.58 / $489.78 / $891.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $457.09 / $977.24
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $831.76 / $2,884.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $501.19 / $776.25
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $501.19 / $831.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.44 / $575.44 / $575.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $426.58 / $575.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$426.58 / $724.44 / $4,265.80
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $407.38 / $5,011.87
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$371.54 / $645.65 / $831.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $407.38 / $812.83