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Montana rates for HCPCS L3762

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.34 / $63.25 / $150.00
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
$116.38 / $116.38 / $116.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.81 / $125.13 / $125.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.81 / $101.76 / $125.13
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.73 / $119.17 / $125.13
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.81 / $93.92 / $125.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.50 / $52.55 / $80.42