go back

Iowa 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
$541.76 / $570.16 / $570.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.18 / $440.74 / $789.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$488.53 / $488.53 / $852.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$488.53 / $951.38 / $1,189.22
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$735.91 / $875.30 / $946.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$486.62 / $969.27 / $3,743.02
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$359.77 / $419.73 / $1,058.39
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$849.60 / $852.10 / $1,095.51
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$697.88 / $995.37 / $1,628.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$359.77 / $386.46 / $911.38
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$735.91 / $735.91 / $735.91
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$581.37 / $735.91 / $735.91