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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
$234.42 / $234.42 / $234.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $169.82 / $426.58
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.00 / $363.08 / $416.87
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $169.82 / $223.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.83 / $177.83 / $177.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $128.82 / $177.83
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $269.15 / $323.59
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.42 / $234.42 / $234.42
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $186.21 / $478.63
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.13 / $141.25 / $141.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $173.78 / $295.12