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California rates for HCPCS L3763

Elbow Wrist Hand Orthosis 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
$433.12 / $433.12 / $2,604.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$358.89 / $433.12 / $1,204.07
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$328.91 / $1,284.00 / $2,865.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$411.12 / $439.23 / $763.14
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.00 / $1,068.58 / $1,908.17
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $1,197.56 / $2,789.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$488.53 / $488.53 / $753.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$356.63 / $356.63 / $679.93
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$733.55 / $880.26 / $992.83
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$541.54 / $631.79 / $1,371.91
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,378.57 / $4,287.21 / $4,287.21
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,332.34 / $4,332.34 / $6,185.25
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,582.12 / $1,582.12 / $1,582.12
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$232.26 / $797.96 / $936.70
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$356.63 / $488.53 / $755.97
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,703.56 / $1,703.56 / $1,703.56
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$722.06 / $733.55 / $953.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.65 / $370.01 / $873.32