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Missouri 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
$655.27 / $655.27 / $872.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$605.58 / $679.10 / $1,036.52
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,251.72 / $1,314.31 / $5,777.94
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$606.19 / $713.17 / $1,012.69
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 / $537.44 / $784.84
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$627.28 / $1,013.15 / $6,310.18
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$486.99 / $624.46 / $1,521.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$460.24 / $624.46 / $1,135.98