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Montana 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 / $3,959.48 / $3,959.48
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,388.14 / $1,388.14 / $1,388.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$907.46 / $1,492.53 / $1,492.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$907.46 / $1,492.53 / $1,492.53
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$700.27 / $1,421.46 / $1,492.53
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$907.46 / $1,120.20 / $1,493.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$566.35 / $626.62 / $717.31