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Massachusetts 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
$331.82 / $340.24 / $340.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$340.24 / $378.48 / $486.62
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$696.74 / $2,218.32 / $4,287.21
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$351.13 / $673.81 / $790.90
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$850.28 / $1,005.58 / $1,294.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$584.63 / $584.63 / $600.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$488.53 / $488.53 / $488.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$356.63 / $488.53 / $951.38
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.51 / $630.51 / $662.04
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$554.38 / $554.38 / $554.38
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,665.78 / $4,287.21 / $4,287.21
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$296.48 / $422.54 / $825.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$304.91 / $422.54 / $812.91