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Minnesota rates for HCPCS L3761

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$381.04 / $381.04 / $381.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$276.64 / $344.89 / $396.64
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$498.58 / $630.65 / $1,225.84
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$438.71 / $531.94 / $548.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$375.73 / $1,692.52 / $4,700.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$635.63 / $673.76 / $807.24
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,004.83 / $1,623.89 / $3,701.45
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$635.63 / $635.63 / $654.40
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$358.79 / $548.39 / $2,563.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.93 / $276.23 / $658.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.93 / $273.31 / $839.27