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Utah 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
$232.26 / $232.26 / $232.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$232.26 / $351.00 / $2,604.13
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 / $697.57
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$337.03 / $543.61 / $706.69
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$652.03 / $727.19 / $727.19
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$414.09 / $521.25 / $781.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$332.63 / $359.77 / $516.13