go back

Wisconsin 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 $871 · 10th–90th $537$1,5850%50%10th90th$871Professionalmedian $603 · 10th–90th $398$1,3180%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
$436.52 / $501.19 / $537.03
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$398.11 / $446.68 / $707.95
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$870.96 / $870.96 / $1,445.44
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$794.33 / $812.83 / $977.24
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$575.44 / $1,995.26 / $4,265.80
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$426.58 / $1,258.93 / $1,659.59
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$436.52 / $741.31 / $1,071.52
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$776.25 / $2,344.23 / $2,951.21
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$436.52 / $851.14 / $4,265.80
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$398.11 / $478.63 / $1,047.13
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $70.79 / $380.19
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,380.38 / $1,380.38 / $1,380.38
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$616.60 / $977.24 / $1,698.24
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$870.96 / $1,318.26 / $2,570.40
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$575.44 / $1,737.80 / $4,897.79
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$426.58 / $851.14 / $5,011.87
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$275.42 / $478.63 / $870.96
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$316.23 / $426.58 / $891.25