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Iowa rates for HCPCS L3762

Elbow orthosis (EO), rigid, without joints, includes soft interface material, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.91 / $81.91 / $86.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.36 / $63.26 / $106.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.81 / $65.81 / $383.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.81 / $136.50 / $170.63
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.47 / $118.56 / $134.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$73.72 / $139.25 / $549.05
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.55 / $61.31 / $160.01
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.69 / $129.07 / $160.01
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.71 / $150.78 / $246.65
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$168.53 / $168.53 / $273.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.08 / $58.54 / $153.26
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$111.47 / $111.47 / $111.47
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.06 / $111.47 / $111.47