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Virginia 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
$219.05 / $264.63 / $264.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$219.05 / $264.63 / $323.64
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$535.20 / $535.20 / $568.38
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.10 / $295.10 / $368.90
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$298.79 / $298.79 / $365.86
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 / $336.03
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$374.64 / $481.68 / $642.24
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$157.77 / $309.62 / $598.01
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$308.00 / $642.00 / $891.49
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$293.23 / $403.92 / $669.00
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$293.23 / $403.92 / $669.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$221.91 / $267.01 / $402.22