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Alaska rates for HCPCS L3765

Elbow-wrist-hand-finger orthosis (EWHFO), rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,175.57 / $1,175.57 / $1,175.57
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$907.46 / $907.46 / $907.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$907.46 / $1,064.96 / $1,153.33
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$404.54 / $404.54 / $404.54
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,303.69 / $1,303.69 / $2,058.46
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$404.54 / $404.54 / $907.46
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$907.46 / $1,064.96 / $1,249.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$663.27 / $1,312.22 / $1,711.59