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Alaska rates for HCPCS L3740

Elbow orthosis (EO), double upright with forearm/arm cuffs, adjustable position lock with active control, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,942.88 / $1,942.88 / $1,942.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$736.22 / $736.22 / $736.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.44 / $736.22 / $784.84
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$379.47 / $379.47 / $379.47
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,123.73 / $2,154.64 / $3,402.06
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$379.47 / $379.47 / $736.22
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.44 / $784.84 / $1,386.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.19 / $1,697.25 / $2,843.36