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Oregon 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
$710.79 / $710.79 / $710.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.00 / $306.10 / $1,206.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$336.03 / $336.03 / $336.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.30 / $245.30 / $336.03
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$374.64 / $1,037.63 / $1,353.33
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$321.06 / $439.85 / $535.20
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$397.96 / $503.09 / $561.96
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$424.84 / $535.20 / $588.72
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$438.65 / $535.20 / $554.38
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$321.06 / $459.12 / $561.96
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.30 / $468.65 / $588.72
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$445.91 / $890.04 / $1,877.69
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$460.27 / $588.72 / $588.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$232.56 / $244.39 / $468.42