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Oregon 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
Professional
Modifier
Low / Median / High Price
$392.73 / $532.94 / $2,994.64
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 / $423.04 / $579.51
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$621.90 / $1,725.12 / $2,249.96
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$532.94 / $763.04 / $1,012.73
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.57 / $835.12 / $932.85
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$705.21 / $851.22 / $936.34
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$799.59 / $888.43 / $888.43
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$516.29 / $777.94 / $932.85
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$423.04 / $777.94 / $977.27
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$740.19 / $1,477.42 / $3,116.89
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$764.05 / $977.27 / $977.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$388.22 / $406.33 / $778.80