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Montana 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
$524.81 / $691.83 / $1,023.29
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $977.24 / $977.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$616.60 / $1,047.13 / $1,047.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $851.14 / $1,047.13
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $977.24 / $1,905.46
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $977.24 / $1,905.46
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562.34 / $933.25 / $1,412.54
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $776.25 / $1,096.48
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $616.60 / $645.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $501.19 / $616.60