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Utah 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
$323.59 / $323.59 / $323.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $562.34 / $5,754.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$616.60 / $616.60 / $616.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $457.09 / $660.69
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $724.44 / $933.25
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $870.96 / $1,513.56
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $707.95 / $1,071.52
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,000.00 / $1,174.90
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $1,023.29 / $1,412.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $501.19 / $660.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $501.19 / $707.95