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Minnesota 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
$94.51 / $381.04 / $381.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$233.85 / $294.22 / $381.04
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$469.77 / $548.39 / $763.61
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$438.71 / $520.97 / $548.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$336.03 / $1,692.52 / $4,700.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$635.63 / $673.76 / $807.24
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,004.83 / $1,623.89 / $3,701.45
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$635.63 / $635.63 / $654.40
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.50 / $548.39 / $2,563.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.93 / $273.31 / $658.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.35 / $407.32 / $967.91