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South Carolina 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
$432.05 / $432.05 / $432.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$415.17 / $432.05 / $764.36
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$625.00 / $853.71 / $1,091.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$579.51 / $579.51 / $639.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$423.04 / $720.64 / $810.24
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$388.45 / $687.26 / $1,442.25
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,095.39 / $1,095.39 / $1,095.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$290.33 / $431.61 / $730.26