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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

Facilitymedian $813 · 10th–90th $427–$1,5490%20%10th90th$813Professionalmedian $468 · 10th–90th $372–$7760%20%40%10th90th$468$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 / $489.78 / $891.25
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$371.54 / $446.68 / $758.58
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$831.76 / $831.76 / $2,884.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$446.68 / $501.19 / $776.25
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$501.19 / $501.19 / $831.76
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$575.44 / $575.44 / $602.56
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$426.58 / $426.58 / $575.44
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$426.58 / $691.83 / $4,265.80
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$309.03 / $407.38 / $5,011.87
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$371.54 / $660.69 / $660.69
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$316.23 / $407.38 / $870.96