go back

Maine 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
$359.78 / $359.78 / $359.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$358.17 / $472.68 / $472.68
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$692.60 / $897.33 / $1,663.37
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$439.23 / $460.21 / $460.21
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 / $676.08
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.51 / $630.51 / $630.51
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$359.78 / $359.78 / $359.78
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$433.12 / $472.68 / $476.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$259.00 / $388.50 / $893.42