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Indiana 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
$406.14 / $468.62 / $823.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$388.11 / $406.14 / $466.55
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$648.26 / $734.42 / $820.58
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$411.12 / $439.23 / $623.70
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$656.48 / $902.64 / $1,230.86
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$697.49 / $902.64 / $1,107.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$488.53 / $488.53 / $820.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$356.63 / $488.53 / $841.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.84 / $399.41 / $604.52