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Montana 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 / $4,532.55 / $4,532.55
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,150.59 / $1,150.59 / $1,150.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$736.22 / $1,237.11 / $1,237.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$736.22 / $1,006.04 / $1,237.11
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$656.88 / $1,178.21 / $1,237.11
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$736.22 / $928.51 / $1,238.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$531.26 / $587.79 / $899.49