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Massachusetts 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
Facility
Modifier
Low / Median / High Price
$686.39 / $686.39 / $686.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$605.58 / $686.39 / $901.28
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$880.00 / $2,915.44 / $7,462.01
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.53 / $944.70 / $1,534.13
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,667.39 / $2,028.58 / $2,612.42
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,131.55 / $1,131.55 / $1,211.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$736.22 / $908.66 / $1,101.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.44 / $736.22 / $1,365.75
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,271.92 / $1,271.92 / $1,335.52
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$749.53 / $749.53 / $749.53
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,152.76 / $7,462.01 / $7,462.01
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$522.48 / $783.73 / $1,534.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$531.26 / $783.73 / $1,453.52