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Idaho rates for HCPCS L3762

Elbow orthosis (EO), rigid, without joints, includes soft interface material, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.50 / $38.50 / $38.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.34 / $77.65 / $100.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.81 / $65.81 / $72.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.04 / $65.81 / $70.16
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.93 / $81.06 / $115.08
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.57 / $109.33 / $115.08
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $84.92 / $101.14
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.76 / $112.38 / $168.57
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.56 / $83.42 / $120.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.59 / $52.55 / $80.98