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Arkansas 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
$428.97 / $428.97 / $428.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$358.89 / $428.97 / $428.97
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$617.41 / $617.41 / $617.41
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$219,999.78 / $539,999.46 / $949,999.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$666.25 / $881.80 / $979.78
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$751.25 / $751.25 / $875.30
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$751.25 / $751.25 / $751.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$488.53 / $488.53 / $617.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$356.63 / $488.53 / $602.94
Qualchoice
Facility/Professional
Professional
Modifier
Low / Median / High Price
$710.03 / $710.03 / $710.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$243.87 / $359.77 / $755.58