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Oklahoma 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
$398.11 / $398.11 / $398.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $467.74 / $707.95
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 / $891.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$354.81 / $660.69 / $4,265.80
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $446.68 / $1,023.29
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $851.14 / $933.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $398.11 / $588.84