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Indiana rates for HCPCS L3730

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $2,137.96 / $2,137.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $549.54 / $812.83
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$602.56 / $1,023.29 / $1,258.93
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $602.56 / $1,047.13
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $1,318.26 / $1,584.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$616.60 / $616.60 / $1,023.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $457.09 / $891.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.19 / $691.83 / $794.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $501.19 / $724.44