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Arizona 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
$588.84 / $741.31 / $1,288.25
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$363.08 / $831.76 / $1,737.80
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,380.38 / $2,630.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$912.01 / $912.01 / $912.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $660.69 / $912.01
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.38 / $933.25 / $2,884.03
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $630.96 / $7,079.46
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $812.83 / $1,096.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $630.96 / $933.25