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Utah 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
$407.38 / $407.38 / $407.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $758.58 / $6,025.60
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 / $977.24
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $1,047.13 / $1,318.26
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $1,258.93 / $2,137.96
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,023.29 / $1,479.11
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,412.54 / $1,445.44
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,445.44 / $1,698.24
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$524.81 / $616.60 / $812.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $630.96 / $891.25