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Wisconsin 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
$594.36 / $594.36 / $594.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$560.26 / $594.36 / $1,064.03
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,178.21 / $1,296.03 / $2,144.34
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,019.03 / $1,095.74 / $1,449.19
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$847.60 / $2,521.37 / $2,521.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$736.22 / $2,436.19 / $4,918.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.44 / $1,707.19 / $2,229.86
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$379.47 / $891.54 / $1,354.94
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$674.62 / $1,178.21 / $1,570.95
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$594.36 / $1,178.21 / $6,310.18
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$533.72 / $685.76 / $1,330.18
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $371.18
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$379.47 / $891.54 / $1,354.94
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$674.62 / $1,178.21 / $1,570.95
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,178.21 / $1,813.21 / $3,527.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$736.22 / $2,301.19 / $6,310.18
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.44 / $736.22 / $9,966.95
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,178.21 / $1,178.21 / $1,178.21
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$940.77 / $1,178.21 / $1,178.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$469.38 / $624.46 / $1,140.69