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Utah 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
$91.20 / $91.20 / $91.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $169.82 / $691.83
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 / $363.08
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $234.42 / $316.23
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.88 / $281.84 / $489.78
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $229.09 / $331.13
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $323.59 / $323.59
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $323.59 / $380.19
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.49 / $141.25 / $186.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $141.25 / $204.17