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Wyoming 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
Professional
Modifier
Low / Median / High Price
$417.00 / $417.00 / $652.03
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$727.19 / $727.19 / $727.19
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$727.19 / $727.19 / $727.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$488.53 / $488.53 / $852.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$356.63 / $356.63 / $488.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$325.16 / $359.77 / $541.94