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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
$426.58 / $426.58 / $426.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $794.33 / $6,309.57
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $831.76 / $831.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $602.56 / $891.25
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $1,096.48 / $1,412.54
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.02 / $1,318.26 / $2,290.87
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,071.52 / $1,548.82
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $1,513.56 / $1,548.82
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,548.82 / $1,778.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $660.69 / $870.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $660.69 / $954.99