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Michigan 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
$313.18 / $313.18 / $766.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$271.42 / $294.55 / $323.64
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$411.29 / $411.29 / $411.29
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$830.03 / $1,653.72 / $3,011.98
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$520.97 / $548.39 / $740.33
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$347.88 / $356.45 / $358.36
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$438.71 / $438.71 / $438.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$321.89 / $336.03 / $336.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.30 / $455.98 / $794.53
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$313.18 / $396.29 / $766.32
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$294.22 / $396.29 / $562.38
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$332.76 / $405.81 / $466.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.35 / $257.52 / $392.49