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Connecticut 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
$380.19 / $380.19 / $380.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $416.87 / $776.25
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$616.60 / $794.33 / $954.99
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $457.09 / $478.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $489.78 / $489.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $354.81 / $354.81
ConnectiCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $501.19 / $501.19
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $562.34 / $794.33
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $549.54 / $549.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$295.12 / $295.12 / $354.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $389.05 / $676.08