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Minnesota 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
$690.50 / $690.50 / $690.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$482.00 / $690.50 / $743.41
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.30 / $993.78 / $1,383.82
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$795.02 / $944.09 / $993.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$620.97 / $3,066.41 / $8,516.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,152.00 / $1,221.11 / $1,463.04
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,820.49 / $2,942.07 / $6,706.05
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,152.00 / $1,152.00 / $1,185.59
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$329.67 / $993.78 / $5,297.15
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$330.52 / $495.79 / $1,192.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$330.52 / $495.79 / $1,157.33