Custom rigid elbow, wrist and hand brace at Samaritan Hospital

Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

HC Ewho Rigid Without Joints Custom Fabricated Restricted Non-Mm Supply

Troy, NY

See all hospitals reporting HCPCS L3763 →

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Pricing by billing methodology

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How this price compares nationally

Samaritan Hospital’s median price of $756 is 9% below the median hospital's median price ($831), higher than 28% of the 1,315 hospitals reporting HCPCS L3763. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting HCPCS L3763 at Samaritan Hospital

Negotiated rates from the hospital’s own file: 16 payers, 38 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.

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1	UnitedHealthcare united healthcare medicaid harp chip facility · fee schedule · both	$502	$502	—	—	—	$502 – $502
2	Aetna aetna facility · percent of total billed charges · bothfrom % of charges	$687	$687	—	—	—	$687 – $687
3	Blue Cross Blue Shield blue shield of ne new york hmo facility · percent of total billed charges · bothfrom % of charges	$687	$687	—	—	—	$687 – $687
4	Blue Cross Blue Shield blue shield of ne new york ppo facility · percent of total billed charges · bothfrom % of charges	$687	$687	—	—	—	$687 – $687
5	Carefirst blue shield of ne new york hmo facility · percent of total billed charges · bothfrom % of charges	$687	$687	—	—	—	$687 – $687
6	Carefirst blue shield of ne new york ppo facility · percent of total billed charges · bothfrom % of charges	$687	$687	—	—	—	$687 – $687
7	Excellus blue shield of ne new york ppo facility · percent of total billed charges · bothfrom % of charges	$687	$687	—	—	—	$687 – $687
8	Highmark blue shield of ne new york ascend facility · percent of total billed charges · bothfrom % of charges	$687	$687	—	—	—	$687 – $687
9	Highmark blue shield of ne new york hmo facility · percent of total billed charges · bothfrom % of charges	$687	$687	—	—	—	$687 – $687
10	Highmark blue shield of ne new york ppo facility · percent of total billed charges · bothfrom % of charges	$687	$687	—	—	—	$687 – $687
11	Medical Mutual aetna facility · percent of total billed charges · bothfrom % of charges	$687	$687	—	—	—	$687 – $687
12	Premera blue shield of ne new york ppo facility · percent of total billed charges · bothfrom % of charges	$687	$687	—	—	—	$687 – $687
13	Regence blue shield of ne new york ppo facility · percent of total billed charges · bothfrom % of charges	$687	$687	—	—	—	$687 – $687
14	Wellmark blue shield of ne new york hmo facility · percent of total billed charges · bothfrom % of charges	$687	$687	—	—	—	$687 – $687
15	Wellmark blue shield of ne new york ppo facility · percent of total billed charges · bothfrom % of charges	$687	$687	—	—	—	$687 – $687
16	Anthem empire bcbs medicare advantage facility · fee schedule · both	$824	$824	—	—	—	$824 – $824
17	Excellus blue shield of ne new york medicare adv facility · fee schedule · both	$841	$841	—	—	—	$841 – $841
18	Highmark blue shield of ne new york medicare adv facility · fee schedule · both	$841	$841	—	—	—	$841 – $841
19	UnitedHealthcare united healthcare medicare advantage facility · fee schedule · both	$857	$857	—	—	—	$857 – $857
20	Aetna aetna medicare advantage facility · fee schedule · both	$890	$890	—	—	—	$890 – $890
21	WellCare wellcare medicare advantage facility · fee schedule · both	$919	$919	—	—	—	$919 – $919
22	UnitedHealthcare united healthcare facility · percent of total billed charges · bothfrom % of charges	$1.3k	$1.3k	$387	29%	—	$945 – $1.7k
23	WellCare wellcare ep 1&2 medicaid facility · fee schedule · both	$1.3k	$1.3k	—	—	—	$1.3k – $1.3k
24	First Health first health facility · percent of total billed charges · bothfrom % of charges	$1.4k	$1.4k	—	—	—	$1.4k – $1.4k
25	Anthem empire bcbs blue access facility · fee schedule · both	$1.4k	$1.4k	—	—	—	$1.4k – $1.4k

Page 1 of 2 · 38 rates

Last updated: Mar 31, 2026

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