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Montana 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 $832 · 10th–90th $575–$1,0470%20%40%10th90th$832Professionalmedian $537 · 10th–90th $355–$1,0470%10%10th90th$537$100.0$200.0$500.0$1.0K$2.0K$5.0K

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
Professional
Modifier
Typical Low / Median / Typical High
$354.81 / $478.63 / $776.25
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$575.44 / $891.25 / $891.25
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$575.44 / $891.25 / $891.25
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$660.69 / $831.76 / $1,621.81
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$660.69 / $831.76 / $1,621.81
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$489.78 / $870.96 / $1,047.13
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $676.08 / $891.25
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$398.11 / $512.86 / $537.03
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$363.08 / $407.38 / $616.60