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Idaho rates for HCPCS L3702

Elbow Orthosis Without Joints May Include Soft Interface Straps Custom Fabricated Includes Fitting And Adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.40 / $234.40 / $234.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.10 / $208.55 / $270.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$176.75 / $176.75 / $193.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.03 / $129.03 / $188.42
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.10 / $217.68 / $309.02
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$278.13 / $293.58 / $309.02
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $230.87 / $278.13
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$270.60 / $301.79 / $452.69
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$216.32 / $224.07 / $324.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.47 / $139.86 / $217.45