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Idaho 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
$619.01 / $1,035.77 / $1,035.77
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$736.22 / $736.22 / $985.32
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 / $888.05 / $1,182.86
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,064.58 / $1,123.73 / $1,182.86
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $872.95 / $1,039.64
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,035.77 / $1,155.15 / $1,732.73
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$828.01 / $828.01 / $1,242.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$543.47 / $587.79 / $916.63