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Ohio 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
$79.97 / $211.03 / $1,410.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$361.80 / $440.74 / $519.92
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$770.52 / $902.64 / $2,338.65
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$411.12 / $439.23 / $1,083.16
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$615.44 / $820.58 / $1,107.78
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$568.95 / $787.77 / $1,757.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$488.53 / $488.53 / $1,025.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$356.63 / $488.53 / $682.30
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$488.53 / $488.53 / $488.53
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$356.63 / $488.53 / $488.53
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$394.67 / $542.67 / $711.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$272.92 / $396.61 / $751.57