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Nebraska 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
$74.83 / $74.83 / $74.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.93 / $74.83 / $126.52
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.01 / $88.01 / $88.01
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.13 / $113.44 / $114.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.81 / $129.07 / $383.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.81 / $129.07 / $199.02
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.07 / $128.44 / $549.05
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.49 / $58.54 / $97.56
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.69 / $129.07 / $162.63
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.32 / $152.54 / $265.89
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.29 / $140.04 / $244.17
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$119.37 / $119.37 / $119.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.44 / $58.54 / $79.27