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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
$794.33 / $794.33 / $794.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $794.33 / $6,760.83
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,202.26 / $1,230.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $741.31 / $1,412.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $1,380.38 / $2,238.72
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.33 / $1,412.54 / $6,309.57
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $630.96 / $1,258.93
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $1,380.38 / $3,162.28
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,412.54 / $1,412.54 / $1,412.54
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $3,162.28 / $3,162.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.09 / $691.83 / $1,348.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $630.96 / $977.24