go back

Missouri 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
$130.50 / $319.20 / $582.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$405.52 / $421.75 / $641.46
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$774.64 / $813.37 / $3,575.74
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.82 / $439.23 / $727.80
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 / $674.98
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$405.52 / $700.27 / $3,743.02
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$298.07 / $386.46 / $947.95
Qualchoice
Facility/Professional
Professional
Modifier
Low / Median / High Price
$710.03 / $710.03 / $710.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$294.92 / $386.46 / $776.87