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Alaska rates for HCPCS L3763

Elbow-wrist-hand orthosis (EWHO), rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$948.29 / $948.29 / $948.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$635.04 / $772.65 / $927.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$488.53 / $488.53 / $488.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$488.53 / $644.12 / $697.57
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$232.26 / $232.26 / $232.26
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$751.70 / $856.86 / $1,352.94
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$232.26 / $232.26 / $488.53
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$488.53 / $644.12 / $755.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$435.94 / $568.97 / $1,740.31