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Utah rates for HCPCS L3765

Elbow Wrist Hand Finger Orthosis 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
$404.54 / $404.54 / $404.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$404.54 / $468.64 / $3,959.48
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 / $1,153.33
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$643.37 / $1,037.70 / $1,349.01
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,244.67 / $1,388.14 / $1,388.14
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$790.45 / $995.02 / $1,492.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$481.44 / $621.04 / $735.96