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Utah 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 $537 · 10th–90th $263–$8510%20%40%10th90th$537Professionalmedian $603 · 10th–90th $263–$4,4670%10%10th90th$603$50.0$100.0$200.0$500.0$1.0K$2.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$263.03 / $263.03 / $263.03
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$263.03 / $489.78 / $4,466.84
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
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $616.60 / $794.33
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$812.83 / $851.14 / $851.14
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$602.56 / $602.56 / $954.99
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$851.14 / $851.14 / $912.01
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$616.60 / $870.96 / $1,096.48
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$338.84 / $398.11 / $537.03
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$316.23 / $407.38 / $794.33