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South Carolina 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
$691.83 / $691.83 / $691.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $724.44 / $1,230.27
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $1,288.25 / $1,659.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$912.01 / $912.01 / $2,238.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $660.69 / $1,621.81
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $707.95 / $933.25
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.08 / $1,023.29 / $2,238.72
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $398.11 / $407.38
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $954.99
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $776.25 / $1,698.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $691.83 / $891.25