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West 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
$602.56 / $602.56 / $602.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $630.96 / $1,047.13
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $758.58 / $1,584.89
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $831.76 / $1,412.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $2,137.96 / $2,137.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $537.03 / $6,456.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$588.84 / $776.25 / $1,348.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $660.69 / $977.24