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Idaho 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
$370.90 / $824.49 / $824.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$355.64 / $570.16 / $692.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$488.53 / $488.53 / $860.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$356.63 / $356.63 / $520.79
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$232.26 / $692.85 / $869.43
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$712.13 / $751.70 / $791.26
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $583.94 / $695.44
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$692.85 / $772.71 / $1,159.07
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$553.88 / $553.88 / $830.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$332.63 / $359.77 / $613.16