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New Mexico 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
$770.32 / $770.32 / $770.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.64 / $1,183.00 / $4,532.55
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$941.19 / $1,254.92 / $1,495.25
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 / $736.22 / $736.22
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,256.76 / $1,570.95 / $2,356.42
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$379.47 / $379.47 / $1,180.58
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.44 / $736.22 / $1,386.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$533.72 / $587.79 / $885.43