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Nebraska 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
$798.24 / $798.24 / $798.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$798.24 / $798.24 / $1,036.52
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,100.14 / $1,210.16 / $1,222.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$736.22 / $1,376.89 / $1,376.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$736.22 / $1,376.89 / $2,123.17
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$627.12 / $1,370.11 / $6,310.18
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$452.89 / $624.46 / $1,040.77
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,372.85 / $1,376.89 / $1,789.89
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,156.00 / $1,627.24 / $2,836.60
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,464.51 / $1,493.80 / $2,604.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$452.73 / $624.46 / $884.55