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Utah rates for HCPCS L3720

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$232.24 / $232.24 / $232.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$232.24 / $373.52 / $2,773.95
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
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$326.36 / $526.40 / $684.32
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$631.39 / $704.17 / $704.17
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$400.97 / $504.75 / $757.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$276.39 / $359.73 / $460.61