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Vermont 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
$107.15 / $107.15 / $107.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $436.52 / $478.63
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.21 / $186.21 / $186.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $489.78 / $489.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $354.81 / $489.78
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $758.58 / $954.99
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$354.81 / $354.81 / $446.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $630.96 / $1,621.81