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Maine 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
$234.00 / $234.00 / $234.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.74 / $186.86 / $187.58
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$274.85 / $356.10 / $660.09
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$171.10 / $180.50 / $180.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$176.75 / $176.75 / $176.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.03 / $129.03 / $176.75
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$250.21 / $250.21 / $250.21
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.00 / $234.00 / $234.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.87 / $176.74 / $187.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.78 / $154.18 / $354.55