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Montana 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
$378.84 / $2,773.95 / $2,773.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$450.57 / $757.12 / $757.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$450.57 / $615.70 / $757.12
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$402.02 / $721.07 / $757.12
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$450.57 / $568.25 / $819.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$325.13 / $359.73 / $417.28