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Montana 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
Professional
Modifier
Low / Median / High Price
$30.20 / $186.21 / $691.83
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $75,857.76 / $95,499.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $309.03 / $309.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.83 / $338.84 / $338.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $275.42 / $338.84
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.47 / $309.03 / $616.60
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $309.03 / $616.60
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.96 / $316.23 / $457.09
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $251.19 / $338.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$141.25 / $177.83 / $186.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $141.25 / $162.18