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Maine rates for HCPCS L3730

Elbow orthosis (EO), double upright with forearm/arm cuffs, extension/ flexion assist, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$578.94 / $804.27 / $804.27
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,178.49 / $1,526.84 / $2,830.29
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$604.33 / $634.17 / $634.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$620.97 / $620.97 / $973.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$453.31 / $453.31 / $620.97
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,072.82 / $1,072.82 / $1,072.82
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$746.09 / $804.27 / $804.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$440.70 / $661.04 / $1,520.19