go back

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

Facilitymedian $813 · 10th–90th $407–$1,4130%20%40%10th90th$813Professionalmedian $977 · 10th–90th $407–$6,0260%5%10%10th90th$977$50.0$100.0$200.0$500.0$1.0K$2.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$407.38 / $407.38 / $407.38
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$407.38 / $794.33 / $6,025.60
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$912.01 / $912.01 / $912.01
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$660.69 / $660.69 / $912.01
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $1,047.13 / $1,318.26
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,348.96 / $1,412.54 / $1,412.54
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$977.24 / $1,023.29 / $1,548.82
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,380.38 / $1,412.54 / $1,445.44
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,023.29 / $1,445.44 / $1,698.24
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$524.81 / $616.60 / $812.83
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$489.78 / $630.96 / $1,047.13