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Missouri 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
$165.96 / $724.44 / $831.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $758.58 / $1,698.24
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,412.54 / $1,412.54 / $5,011.87
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $741.31 / $1,318.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $851.14 / $1,412.54
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
$707.95 / $1,122.02 / $6,606.93
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $691.83 / $7,079.46
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.44 / $1,122.02 / $1,348.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $676.08 / $1,000.00