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Missouri 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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$281.84 / $281.84 / $323.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $295.12 / $1,148.15
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $407.38 / $407.38
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562.34 / $562.34 / $1,949.84
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $302.00 / $512.86
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $331.13 / $562.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$323.59 / $338.84 / $338.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $245.47 / $338.84
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$275.42 / $446.68 / $2,570.40
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $269.15 / $2,754.23
Qualchoice
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $512.86 / $512.86
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$223.87 / $436.52 / $524.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $263.03 / $389.05