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Texas 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 $692 · 10th–90th $355–$3,1620%10%20%10th90th$692Professionalmedian $407 · 10th–90th $372–$6170%50%10th90th$407$1.0$5.0$20.0$100.0$500.0$2.0K

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
$173.78 / $371.54 / $389.05
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$371.54 / $416.87 / $602.56
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$851.14 / $851.14 / $851.14
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,162.28 / $3,388.44 / $4,168.69
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$398.11 / $398.11 / $398.11
Christus
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$79.43 / $851.14 / $851.14
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$575.44 / $575.44 / $575.44
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$426.58 / $426.58 / $575.44
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,365.16 / $4,365.16 / $4,365.16
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5,128.61 / $7,762.47 / $7,762.47
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$363.08 / $812.83 / $1,318.26
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$371.54 / $426.58 / $851.14
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$363.08 / $416.87 / $416.87
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$371.54 / $776.25 / $1,288.25
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$426.58 / $426.58 / $575.44
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$338.84 / $691.83 / $933.25
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$338.84 / $501.19 / $602.56
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$489.78 / $851.14 / $851.14