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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
$18.00 / $169.87 / $697.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$312.60 / $312.60 / $312.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$176.75 / $336.11 / $336.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$176.75 / $336.11 / $336.11
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$157.69 / $320.10 / $336.11
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$176.75 / $252.26 / $336.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.54 / $141.11 / $235.19