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Idaho 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
$522.11 / $1,014.65 / $1,014.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$620.97 / $620.97 / $831.09
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 / $869.93 / $1,158.76
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,042.88 / $1,100.82 / $1,158.76
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $865.67 / $1,042.88
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,014.65 / $1,131.59 / $1,697.40
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$811.13 / $811.13 / $1,216.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$458.39 / $495.79 / $774.24