go back

Illinois rates for HCPCS L3760

Elbow Orthosis (Eo) With Adjustable Position Locking Joint(S) Prefabricated Item That Has Been Trimmed Bent Molded Assembled Or Otherwise Customized To Fit A Specific Patient By An Individual With Expertise (Desc Revised 1/1/2018)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$281.86 / $313.27 / $797.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$232.91 / $294.22 / $436.88
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$655.08 / $1,108.28 / $4,718.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$326.68 / $416.78 / $416.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$321.89 / $336.03 / $600.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.30 / $245.30 / $641.98
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$439.84 / $575.80 / $767.75
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$712.91 / $712.91 / $712.91
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.58 / $442.27 / $464.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$203.66 / $273.58 / $576.95