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Arizona 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
$537.03 / $691.83 / $3,162.28
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $954.99 / $1,995.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,584.89 / $3,019.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $741.31 / $741.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $537.03 / $741.31
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.19 / $1,096.48 / $6,309.57
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $588.84 / $10,000.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $776.25 / $1,258.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $588.84 / $891.25