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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
$156.71 / $298.95 / $1,368.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.69 / $162.75 / $170.07
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$250.15 / $283.39 / $316.64
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.46 / $171.10 / $233.45
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$238.76 / $348.30 / $474.96
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.14 / $348.30 / $427.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$176.75 / $176.75 / $316.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.03 / $176.75 / $324.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.08 / $151.37 / $212.62