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Utah 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
$217.04 / $217.04 / $217.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$217.04 / $306.02 / $1,544.22
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 / $375.73 / $635.63
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $365.58 / $507.75
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$485.44 / $541.39 / $541.39
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$388.07 / $388.07 / $582.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.35 / $244.39 / $293.92