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Utah 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
$428.38 / $428.38 / $428.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$428.38 / $496.26 / $4,192.77
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 / $1,226.75
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$681.28 / $1,098.83 / $1,428.49
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,318.01 / $1,469.93 / $1,469.93
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$837.03 / $1,053.65 / $1,580.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$519.54 / $657.63 / $849.61