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Indiana 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
$58.35 / $78.31 / $143.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.11 / $60.59 / $90.74
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.42 / $115.00 / $123.78
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.13 / $105.51 / $117.89
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.52 / $64.01 / $88.33
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$88.92 / $129.68 / $176.84
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.21 / $129.68 / $159.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.81 / $65.81 / $383.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.04 / $65.81 / $120.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$168.53 / $168.53 / $168.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.03 / $56.20 / $79.17