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Alaska rates for HCPCS L3702

Elbow orthosis (EO), without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$386.10 / $504.70 / $720.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.87 / $264.73 / $336.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$176.75 / $176.75 / $176.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.03 / $176.75 / $188.42
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.10 / $91.10 / $91.10
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$293.58 / $293.58 / $463.55
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.10 / $91.10 / $176.75
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.03 / $188.42 / $362.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$149.36 / $295.50 / $385.44