go back

Idaho 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
$540.74 / $1,201.65 / $1,201.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$860.73 / $907.46 / $907.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$662.45 / $662.45 / $967.40
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$404.54 / $966.66 / $1,372.31
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,235.08 / $1,303.69 / $1,372.31
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $1,025.22 / $1,235.08
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,201.65 / $1,340.15 / $2,010.23
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$960.62 / $995.02 / $1,440.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$579.37 / $626.62 / $965.61