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South Carolina 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
$519.57 / $519.57 / $519.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$519.57 / $519.57 / $919.20
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$610.00 / $769.04 / $1,112.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$467.55 / $620.97 / $685.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$453.31 / $620.97 / $631.29
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$467.13 / $752.00 / $1,648.63
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$590.00 / $590.00 / $634.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$709.34 / $709.34 / $709.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$349.14 / $498.36 / $668.36