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Virginia 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
$482.22 / $582.54 / $582.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$482.22 / $582.54 / $707.64
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,178.21 / $1,178.21 / $1,251.26
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$713.17 / $713.17 / $891.53
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$632.00 / $632.00 / $805.42
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$824.75 / $1,060.39 / $1,413.85
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$379.47 / $724.62 / $1,341.18
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$663.00 / $1,472.76 / $1,962.52
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.51 / $889.18 / $1,406.17
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.51 / $889.18 / $1,406.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$531.26 / $587.79 / $885.43