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Missouri rates for HCPCS L3702

Elbow Orthosis Without Joints May Include Soft Interface Straps Custom Fabricated Includes Fitting And Adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.05 / $164.96 / $198.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.75 / $170.96 / $260.94
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$315.12 / $330.88 / $1,454.59
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.60 / $171.10 / $259.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$176.75 / $176.75 / $180.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.03 / $129.03 / $188.42
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$157.57 / $256.44 / $1,474.48
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.91 / $157.21 / $383.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.91 / $157.21 / $239.22