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Nebraska rates for HCPCS L3730

Elbow orthosis (EO), double upright with forearm/arm cuffs, extension/ flexion assist, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$754.67 / $754.67 / $754.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$754.67 / $754.67 / $979.95
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,040.08 / $1,144.09 / $1,155.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$620.97 / $1,301.75 / $1,301.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$620.97 / $1,301.75 / $2,007.32
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$592.89 / $1,295.33 / $5,297.15
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$393.59 / $590.39 / $983.98
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,297.94 / $1,301.75 / $1,640.16
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,066.14 / $1,520.61 / $2,681.80
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,384.59 / $1,412.28 / $2,462.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$415.54 / $590.39 / $746.09