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Elbow Orthosis (EO), Double Upright Free Motion

South Dakota rates for HCPCS L3720

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

Rates data updated July 2026.

Facilitymedian $550 · 10th–90th $550$8510%50%90th$550Professionalmedian $692 · 10th–90th $479$1,0960%10%20%10th90th$692$500.0$1.0K$2.0K$5.0K

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
$549.54
Median
$549.54
Typical High
$549.54
Aetna
Setting
Professional
Modifier
Global
Typical Low
$478.63
Median
$489.78
Typical High
$758.58
Cigna
Setting
Facility
Modifier
Global
Typical Low
$446.68
Median
$446.68
Typical High
$851.14
Cigna
Setting
Professional
Modifier
Global
Typical Low
$870.96
Median
$870.96
Typical High
$1,096.48
Medica
Setting
Facility
Modifier
Global
Typical Low
$630.96
Median
$724.44
Typical High
$1,348.96
Medica
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$512.86
Typical High
$6,165.95
Midlands
Setting
Professional
Modifier
Global
Typical Low
$691.83
Median
$831.76
Typical High
$831.76
Midlands
Setting
Facility
Modifier
Global
Typical Low
$851.14
Median
$851.14
Typical High
$851.14
Midlands
Setting
Professional
Modifier
Global
Typical Low
$691.83
Median
$691.83
Typical High
$1,288.25
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$602.56
Median
$724.44
Typical High
$954.99
United
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$416.87
Typical High
$602.56
United
Setting
Professional
Modifier
Global
Typical Low
$281.84
Median
$549.54
Typical High
$870.96
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$724.44
Median
$724.44
Typical High
$724.44