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Louisiana 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
Facility
Modifier
Low / Median / High Price
$763.95 / $810.96 / $1,092.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$671.32 / $810.96 / $976.94
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,230.30 / $2,101.79 / $2,954.35
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$839.02 / $1,003.59 / $1,003.59
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$907.46 / $907.46 / $907.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$662.45 / $907.46 / $1,124.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$417.75 / $652.00 / $1,039.93