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Washington 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
$77.65 / $104.74 / $184.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.18 / $69.58 / $150.00
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$155.36 / $155.36 / $155.36
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.76 / $239.32 / $549.05
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.94 / $100.12 / $593.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.96 / $65.81 / $383.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.04 / $48.04 / $71.19
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.43 / $115.08 / $301.87
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.50 / $116.75 / $223.42
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.39 / $88.22 / $97.04
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.35 / $112.38 / $119.17
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.42 / $115.08 / $126.59
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.76 / $129.24 / $224.76
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.52 / $95.52 / $95.52
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.53 / $112.38 / $112.38
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.42 / $97.82 / $126.59
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.44 / $168.53 / $168.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.59 / $52.55 / $100.25
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.40 / $54.40 / $97.82