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Texas 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
$701.55 / $715.30 / $729.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$605.58 / $729.06 / $1,033.04
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,456.92 / $5,821.21 / $8,577.84
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$747.63 / $747.63 / $935.39
Baylor Scott & White
Facility/Professional
Professional
Modifier
Low / Median / High Price
$650.00 / $1,178.21 / $1,570.95
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,570.95 / $1,570.95 / $1,570.95
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 / $736.22
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,152.76 / $6,310.18 / $7,462.01
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,966.95 / $10,206.18 / $10,901.40
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$379.47 / $1,049.67 / $1,570.95
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$379.47 / $1,328.47 / $1,570.95
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,442.13 / $1,602.37 / $3,605.33
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$379.47 / $1,049.67 / $1,570.95
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.44 / $537.44 / $784.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$486.99 / $708.35 / $843.27
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$705.87 / $713.17 / $1,570.95