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Utah rates for HCPCS L3740

Elbow Orthosis 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
$379.47 / $379.47 / $379.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$379.47 / $536.48 / $4,532.55
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 / $784.84
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$533.27 / $860.12 / $1,118.15
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,031.68 / $1,150.59 / $1,150.59
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.19 / $824.75 / $1,237.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$460.24 / $587.79 / $843.27