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Montana 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
Professional
Modifier
Low / Median / High Price
$572.61 / $4,192.77 / $4,192.77
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,469.93 / $1,469.93 / $1,469.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.10 / $1,580.47 / $1,580.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.10 / $1,580.47 / $1,580.47
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.54 / $1,505.21 / $1,580.47
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.10 / $1,186.21 / $1,581.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$599.72 / $663.55 / $759.58