go back

Wisconsin 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
$276.64 / $276.64 / $536.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$233.85 / $294.22 / $381.04
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$548.39 / $603.23 / $998.07
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$488.52 / $510.00 / $674.51
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$394.51 / $1,173.55 / $1,173.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$336.03 / $1,134.14 / $2,289.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.30 / $913.33 / $1,037.88
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$157.77 / $414.96 / $630.65
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$313.99 / $535.20 / $658.07
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$273.12 / $575.80 / $2,563.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.96 / $285.12 / $597.13
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $353.40
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$157.77 / $414.96 / $630.65
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$313.99 / $535.20 / $658.07
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$548.39 / $843.96 / $1,466.41
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$336.03 / $1,071.08 / $2,563.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.30 / $336.03 / $2,760.81
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$548.39 / $548.39 / $548.39
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$548.39 / $548.39 / $548.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$203.66 / $285.12 / $548.39