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Indiana 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
$158.49 / $398.11 / $1,380.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $165.96 / $316.23
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $302.00 / $302.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.82 / $323.59 / $407.38
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $169.82 / $309.03
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.23 / $398.11 / $478.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.82 / $177.83 / $323.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $128.82 / $275.42
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.65 / $213.80 / $251.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $151.36 / $213.80