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Wyoming 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
Professional
Modifier
Low / Median / High Price
$476.68 / $476.68 / $745.35
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.27 / $831.27 / $831.27
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.27 / $831.27 / $831.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$579.51 / $579.51 / $895.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$423.04 / $423.04 / $579.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$367.25 / $406.33 / $602.50