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Illinois rates for HCPCS L3765

Elbow Wrist Hand Finger Orthosis Rigid Without Joints May Include Soft Interface Straps Custom Fabricated Includes Fitting And Adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$722.67 / $722.67 / $722.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$564.78 / $722.67 / $1,175.57
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,680.63 / $2,843.33 / $12,097.83
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$906.23 / $1,068.58 / $1,068.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$907.46 / $907.46 / $1,539.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$662.45 / $1,025.79 / $1,423.64
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,161.85 / $1,530.89 / $1,786.48
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,827.84 / $1,827.84 / $1,827.84
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$916.79 / $1,309.70 / $1,375.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$522.19 / $698.01 / $1,204.16