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Utah 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
$33.93 / $38.50 / $38.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.00 / $63.25 / $258.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.81 / $65.81 / $383.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.04 / $65.81 / $71.19
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.13 / $87.00 / $113.10
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.35 / $116.38 / $116.38
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.28 / $83.42 / $125.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.38 / $52.08 / $63.20