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South Carolina 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
$740.91 / $740.91 / $740.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$673.47 / $740.91 / $1,310.78
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$800.00 / $1,038.80 / $1,588.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.10 / $831.10 / $917.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$606.70 / $969.00 / $1,195.75
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$666.13 / $1,095.39 / $2,350.94
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,095.39 / $1,095.39 / $1,095.39
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,011.53 / $1,011.53 / $1,011.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$497.87 / $718.84 / $999.54