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Minnesota 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
$575.44 / $912.01 / $1,174.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $457.09 / $724.44
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $812.83 / $1,202.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $812.83 / $812.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,778.28 / $3,090.30 / $7,413.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,096.48 / $1,202.26
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,398.83 / $3,019.95 / $5,754.40
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $954.99 / $1,288.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.88 / $812.83 / $1,659.59
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.88 / $363.08 / $851.14
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.75 / $354.81 / $977.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $398.11 / $1,023.29