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Texas 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
$344.65 / $358.17 / $721.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$337.90 / $358.17 / $581.17
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$459.84 / $459.84 / $459.84
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,456.92 / $5,821.21 / $8,577.84
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$367.29 / $367.29 / $459.54
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$771.77 / $771.77 / $771.77
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 / $356.63 / $661.20
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,665.78 / $4,287.21 / $4,287.21
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,332.34 / $4,332.34 / $6,185.25
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$232.26 / $580.00 / $944.47
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$232.26 / $694.59 / $791.26
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.10 / $708.49 / $1,771.22
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$232.26 / $502.52 / $902.57
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$356.63 / $488.53 / $666.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$299.81 / $443.51 / $555.96
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$432.06 / $439.23 / $771.77