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Hawaii 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
Professional
Modifier
Low / Median / High Price
$450.61 / $450.61 / $450.61
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$753.96 / $753.96 / $753.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$488.53 / $488.53 / $1,043.99
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$949.08 / $993.80 / $993.80
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$569.45 / $949.08 / $1,328.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$599.61 / $939.59 / $1,043.99
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$679.28 / $790.72 / $903.35