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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
$320.07 / $320.07 / $320.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$320.07 / $452.50 / $3,823.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$620.97 / $620.97 / $620.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$453.31 / $620.97 / $661.98
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$449.79 / $725.48 / $943.12
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.19 / $970.49 / $970.49
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$552.63 / $695.65 / $1,043.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$388.20 / $495.79 / $634.80