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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
$281.84 / $281.84 / $323.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $309.03 / $645.65
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $416.87 / $588.84
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562.34 / $562.34 / $1,949.84
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $302.00 / $891.25
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $331.13 / $562.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$371.54 / $371.54 / $380.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $275.42 / $371.54
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$295.12 / $457.09 / $2,570.40
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $269.15 / $2,754.23
Qualchoice
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $501.19 / $501.19
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.42 / $436.52 / $524.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $269.15 / $436.52