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Vermont rates for HCPCS L3730

Elbow orthosis (EO), double upright with forearm/arm cuffs, extension/ flexion assist, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $602.56 / $812.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$616.60 / $616.60 / $977.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $457.09 / $660.69
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,258.93 / $1,318.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $616.60 / $660.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $776.25 / $2,754.23