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Hawaii rates for HCPCS L3761

Elbow orthosis (EO), with adjustable position locking joint(s), prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$315.68 / $328.44 / $344.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$375.73 / $375.73 / $375.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$375.73 / $375.73 / $588.72
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$535.20 / $560.41 / $560.41
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$374.64 / $535.20 / $749.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$287.02 / $529.85 / $588.72
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$431.13 / $445.91 / $509.42