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Maine 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
$686.39 / $953.53 / $953.53
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,397.20 / $1,810.21 / $3,355.55
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$713.17 / $751.87 / $751.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$736.22 / $736.22 / $1,154.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.44 / $537.44 / $736.22
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,271.92 / $1,271.92 / $1,271.92
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$884.55 / $953.53 / $953.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$522.48 / $783.73 / $1,802.32