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Elbow Orthosis (EO), Double Upright Free Motion

Utah rates for HCPCS L3720

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

Rates data updated July 2026.

Facilitymedian $363 · 10th–90th $234$7240%20%40%10th90th$363Professionalmedian $457 · 10th–90th $234$4,1690%10%10th90th$457$50.0$100.0$200.0$500.0$1.0K$2.0K

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
$234.42
Median
$234.42
Typical High
$234.42
Aetna
Setting
Professional
Modifier
Global
Typical Low
$234.42
Median
$371.54
Typical High
$4,168.69
Cigna
Setting
Facility
Modifier
Global
Typical Low
$446.68
Median
$446.68
Typical High
$446.68
Cigna
Setting
Professional
Modifier
Global
Typical Low
$331.13
Median
$331.13
Typical High
$446.68
Molina
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$524.81
Typical High
$691.83
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$691.83
Median
$724.44
Typical High
$724.44
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$398.11
Median
$512.86
Typical High
$977.24
Select Health
Setting
Facility
Modifier
Global
Typical Low
$741.31
Median
$741.31
Typical High
$741.31
Select Health
Setting
Professional
Modifier
Global
Typical Low
$371.54
Median
$741.31
Typical High
$870.96
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$512.86
Median
$741.31
Typical High
$1,047.13
United
Setting
Facility
Modifier
Global
Typical Low
$302.00
Median
$446.68
Typical High
$660.69
United
Setting
Professional
Modifier
Global
Typical Low
$281.84
Median
$363.08
Typical High
$549.54