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Montana rates for HCPCS L3761

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$315.68 / $344.89 / $379.38
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$541.39 / $541.39 / $541.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$375.73 / $582.10 / $582.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$375.73 / $582.10 / $582.10
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$375.73 / $554.38 / $582.10
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$375.73 / $436.90 / $582.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$236.77 / $244.39 / $394.61