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Michigan 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
$197.75 / $468.62 / $848.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$378.48 / $468.62 / $476.43
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,242.00 / $2,474.54 / $4,506.95
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$779.55 / $820.58 / $1,107.78
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$488.31 / $533.38 / $568.95
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.46 / $656.46 / $656.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$488.53 / $488.53 / $488.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$408.14 / $488.53 / $951.38
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$197.75 / $593.00 / $858.96
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$459.88 / $593.00 / $922.94
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$516.14 / $607.23 / $698.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.70 / $385.36 / $587.30