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Alaska rates for HCPCS L3720

Elbow orthosis (EO), double upright with forearm/arm cuffs, free motion, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,198.27 / $1,198.27 / $1,198.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$450.57 / $450.57 / $450.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$328.92 / $450.57 / $480.33
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$232.24 / $232.24 / $232.24
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$818.22 / $1,328.87 / $2,098.21
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$232.24 / $232.24 / $450.57
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$328.92 / $480.33 / $915.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.07 / $1,337.54 / $1,744.62