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Nebraska 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
$944.83 / $944.83 / $944.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$944.83 / $944.83 / $1,226.86
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,302.16 / $1,432.38 / $1,446.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.10 / $1,629.73 / $1,629.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.10 / $1,629.73 / $2,513.10
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$745.93 / $1,621.72 / $6,933.23
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$511.26 / $739.15 / $1,159.58
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,624.97 / $1,629.73 / $2,053.42
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,455.00 / $1,926.04 / $3,357.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$535.87 / $739.15 / $1,001.24