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Elbow Orthosis (EO), Double Upright Free Motion

Pennsylvania rates for HCPCS L3720

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

Rates data updated July 2026.

Facilitymedian $977 · 10th–90th $316$3,7150%20%10th90th$977Professionalmedian $380 · 10th–90th $316$6310%50%10th90th$380$1.0$10.0$100.0$1.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$316.23
Median
$316.23
Typical High
$1,230.27
Aetna
Setting
Professional
Modifier
Global
Typical Low
$316.23
Median
$371.54
Typical High
$602.56
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$5,011.87
Median
$8,511.38
Typical High
$77,624.71
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$426.58
Median
$630.96
Typical High
$776.25
Cigna
Setting
Facility
Modifier
Global
Typical Low
$446.68
Median
$446.68
Typical High
$1,122.02
Cigna
Setting
Professional
Modifier
Global
Typical Low
$331.13
Median
$331.13
Typical High
$446.68
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$912.01
Median
$1,288.25
Typical High
$1,862.09
Geisinger
Setting
Facility
Modifier
Global
Typical Low
$776.25
Median
$776.25
Typical High
$776.25
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$467.74
Median
$549.54
Typical High
$776.25
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$575.44
Median
$575.44
Typical High
$575.44
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$316.23
Median
$316.23
Typical High
$1,230.27
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$316.23
Median
$371.54
Typical High
$630.96
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$870.96
Median
$870.96
Typical High
$870.96
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$724.44
Median
$2,754.23
Typical High
$4,466.84
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$549.54
Median
$724.44
Typical High
$912.01
United
Setting
Facility
Modifier
Global
Typical Low
$354.81
Median
$977.24
Typical High
$977.24
United
Setting
Professional
Modifier
Global
Typical Low
$302.00
Median
$380.19
Typical High
$831.76