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Maine 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
$34.54 / $34.54 / $34.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$255.84 / $324.86 / $344.89
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$476.01 / $616.71 / $1,143.19
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$301.51 / $301.51 / $301.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$375.73 / $375.73 / $375.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$274.27 / $274.27 / $375.73
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$433.34 / $433.34 / $433.34
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.54 / $34.54 / $34.54
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$315.69 / $324.86 / $344.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$178.01 / $276.23 / $625.14