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Arizona 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
$177.83 / $177.83 / $177.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $169.82 / $691.83
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $234.42 / $234.42
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.28 / $186.21 / $389.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $309.03 / $588.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.83 / $177.83 / $177.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $128.82 / $177.83
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.20 / $208.93 / $645.65
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $141.25 / $1,584.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.13 / $186.21 / $245.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $141.25 / $213.80