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Washington 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 $891 · 10th–90th $603$1,9950%20%10th90th$891Professionalmedian $603 · 10th–90th $398$1,2880%20%10th90th$603$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
$602.56 / $1,174.90 / $1,412.54
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$371.54 / $489.78 / $776.25
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$776.25 / $870.96 / $870.96
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$776.25 / $776.25 / $1,000.00
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$323.59 / $575.44 / $575.44
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$426.58 / $426.58 / $575.44
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$512.86 / $1,202.26 / $2,511.89
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$512.86 / $1,047.13 / $1,905.46
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $676.08 / $741.31
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$707.95 / $870.96 / $891.25
Pacific Source
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$891.25 / $891.25 / $891.25
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$776.25 / $1,288.25 / $1,778.28
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$741.31 / $741.31 / $870.96
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$870.96 / $870.96 / $870.96
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$776.25 / $776.25 / $1,000.00
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$398.11 / $1,318.26 / $1,318.26
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$380.19 / $478.63 / $794.33
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$309.03 / $630.96 / $1,348.96