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Pennsylvania 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 $1,096 · 10th–90th $407–$1,5490%20%10th90th$1,096Professionalmedian $457 · 10th–90th $389–$8910%50%10th90th$457$1.0$10.0$100.0$1.0K$10.0K

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
$407.38 / $1,548.82 / $1,548.82
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$389.05 / $446.68 / $676.08
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,011.87 / $8,511.38 / $77,624.71
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$977.24 / $977.24 / $977.24
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$575.44 / $575.44 / $912.01
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$426.58 / $426.58 / $575.44
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$977.24 / $1,380.38 / $1,995.26
Geisinger
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,000.00 / $1,000.00 / $1,000.00
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$602.56 / $707.95 / $1,000.00
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$407.38 / $407.38 / $407.38
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$398.11 / $467.74 / $660.69
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.60 / $1,479.11 / $2,041.74
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$707.95 / $707.95 / $933.25
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$173.78 / $707.95 / $933.25
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$398.11 / $1,096.48 / $1,258.93
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$363.08 / $489.78 / $1,000.00