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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
$166.97 / $166.97 / $838.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$722.67 / $759.08 / $1,158.59
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,399.13 / $1,469.09 / $6,458.38
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$695.41 / $735.52 / $1,150.83
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 / $1,115.98
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$699.67 / $1,138.61 / $6,547.41
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$519.16 / $698.01 / $1,700.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$519.16 / $698.01 / $1,111.10