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Vermont 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
Professional
Modifier
Low / Median / High Price
$162.50 / $261.18 / $301.37
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.92 / $302.92 / $350.67
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$433.01 / $433.01 / $433.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$321.89 / $336.03 / $393.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.30 / $245.30 / $305.08
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$321.89 / $336.03 / $393.38
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.30 / $245.30 / $305.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$185.13 / $317.05 / $618.74