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Missouri rates for HCPCS L3766

Elbow-wrist-hand-finger orthosis (EWHFO), includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$775.60 / $775.60 / $1,033.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$765.26 / $803.81 / $1,226.86
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,481.57 / $1,555.65 / $6,838.93
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$736.39 / $804.54 / $1,218.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.10 / $831.10 / $831.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$606.70 / $831.10 / $1,187.03
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$740.91 / $1,205.72 / $6,933.23
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.75 / $739.15 / $1,800.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.75 / $739.15 / $1,095.72