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Missouri 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
$285.67 / $285.67 / $395.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.86 / $296.06 / $451.88
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$409.27 / $441.02 / $593.44
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$545.69 / $572.97 / $2,518.91
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.74 / $301.51 / $461.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$375.73 / $375.73 / $383.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$274.27 / $274.27 / $400.55
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$296.06 / $468.87 / $2,563.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$203.66 / $272.24 / $663.28
Qualchoice
Facility/Professional
Professional
Modifier
Low / Median / High Price
$507.17 / $507.17 / $507.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$203.66 / $272.24 / $444.08