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Utah 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
$157.77 / $157.77 / $157.77
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$157.77 / $294.22 / $1,544.22
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 / $245.30 / $705.54
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$250.92 / $404.71 / $526.12
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$485.44 / $541.39 / $541.39
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$308.29 / $388.07 / $582.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.35 / $244.39 / $287.02