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Alaska rates for HCPCS L3730

Elbow orthosis (EO), double upright with forearm/arm cuffs, extension/ flexion assist, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,292.33 / $1,292.33 / $1,705.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$620.97 / $620.97 / $620.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$453.31 / $620.97 / $661.98
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$320.07 / $320.07 / $320.07
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,100.82 / $1,433.19 / $2,262.92
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$320.07 / $320.07 / $620.97
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$453.31 / $661.98 / $1,261.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$729.15 / $1,442.55 / $1,881.59