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Vermont 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
Professional
Modifier
Low / Median / High Price
$489.78 / $707.95 / $912.01
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,258.93 / $1,258.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $741.31 / $1,148.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $537.03 / $776.25
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,412.54 / $1,584.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$588.84 / $741.31 / $912.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $933.25 / $3,311.31