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Nebraska rates for HCPCS L3763

Elbow Wrist Hand Orthosis 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
$477.50 / $494.00 / $955.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$494.00 / $494.00 / $955.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$680.83 / $748.91 / $756.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$488.53 / $852.10 / $852.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$488.53 / $852.10 / $1,313.96
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$411.12 / $847.91 / $3,743.02
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$277.20 / $386.46 / $644.10
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$849.60 / $852.10 / $1,095.51
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$761.00 / $1,007.03 / $1,755.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$280.18 / $386.46 / $568.97