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Indiana rates for HCPCS L3761

Elbow orthosis (EO), with adjustable position locking joint(s), prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$271.42 / $271.42 / $548.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$260.99 / $281.86 / $344.89
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$411.29 / $411.29 / $411.29
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$433.23 / $490.81 / $548.39
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$266.47 / $301.51 / $416.08
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$413.49 / $603.23 / $822.59
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$466.13 / $603.23 / $740.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$375.73 / $375.73 / $548.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$274.27 / $375.73 / $562.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.93 / $266.47 / $394.61