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Ohio 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
$113.73 / $294.55 / $992.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.76 / $294.55 / $438.87
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$411.29 / $411.29 / $822.59
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$514.94 / $603.23 / $1,562.91
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$301.51 / $394.61 / $833.10
Aultcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$466.13 / $466.13 / $466.13
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$411.29 / $548.39 / $740.33
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$358.36 / $496.19 / $1,174.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$375.73 / $375.73 / $646.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$274.27 / $274.27 / $455.98
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$375.73 / $375.73 / $383.66
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$274.27 / $375.73 / $383.66
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.00 / $401.50 / $526.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.57 / $265.05 / $394.61