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Idaho 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
$234.42 / $234.42 / $234.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $186.21 / $281.84
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.78 / $295.12 / $457.09
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $346.74 / $346.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.83 / $177.83 / $194.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $128.82 / $177.83
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.20 / $302.00 / $323.59
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $281.84 / $316.23
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $269.15
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$295.12 / $302.00 / $302.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.78 / $229.09 / $346.74
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $316.23 / $323.59
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$141.25 / $165.96 / $186.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $141.25 / $194.98