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Michigan 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
$567.53 / $567.53 / $567.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$513.41 / $567.53 / $644.01
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,504.15 / $2,996.84 / $5,458.24
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$944.09 / $993.78 / $1,341.60
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.96 / $645.96 / $682.34
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$795.02 / $795.02 / $795.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$620.97 / $620.97 / $620.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$620.97 / $620.97 / $1,152.00
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$567.53 / $718.15 / $718.15
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$567.53 / $718.15 / $1,043.46
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$603.02 / $735.40 / $845.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$388.20 / $475.09 / $711.27