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Illinois 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
$250.99 / $421.76 / $726.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$351.41 / $421.76 / $789.44
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$981.03 / $1,659.73 / $7,060.43
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$496.84 / $623.64 / $623.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$488.53 / $488.53 / $852.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$356.63 / $620.42 / $852.10
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$698.64 / $925.50 / $1,283.84
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,066.75 / $1,066.75 / $1,066.75
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$463.23 / $661.77 / $694.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$299.81 / $409.38 / $798.54