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Elbow Orthosis (EO), Double Upright Adjustable Position Lock

South Dakota rates for HCPCS L3740

Elbow orthosis (EO), double upright with forearm/arm cuffs, adjustable position lock with active control, custom fabricated

Rates data updated July 2026.

Facilitymedian $1,202 · 10th–90th $813$1,6220%20%10th90th$1,202Professionalmedian $1,047 · 10th–90th $794$1,6980%20%10th90th$1,047$500.0$1.0K$2.0K$5.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$851.14
Median
$851.14
Typical High
$851.14
Aetna
Setting
Professional
Modifier
Global
Typical Low
$794.33
Median
$812.83
Typical High
$1,047.13
Cigna
Setting
Facility
Modifier
Global
Typical Low
$741.31
Median
$741.31
Typical High
$1,412.54
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1,380.38
Median
$1,380.38
Typical High
$1,698.24
Medica
Setting
Facility
Modifier
Global
Typical Low
$1,000.00
Median
$1,202.26
Typical High
$2,187.76
Medica
Setting
Professional
Modifier
Global
Typical Low
$467.74
Median
$851.14
Typical High
$10,000.00
Midlands
Setting
Professional
Modifier
Global
Typical Low
$1,148.15
Median
$1,380.38
Typical High
$1,380.38
Midlands
Setting
Facility
Modifier
Global
Typical Low
$1,412.54
Median
$1,412.54
Typical High
$1,412.54
Midlands
Setting
Professional
Modifier
Global
Typical Low
$1,148.15
Median
$1,148.15
Typical High
$2,089.30
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$977.24
Median
$1,174.90
Typical High
$1,548.82
United
Setting
Facility
Modifier
Global
Typical Low
$645.65
Median
$691.83
Typical High
$977.24
United
Setting
Professional
Modifier
Global
Typical Low
$457.09
Median
$891.25
Typical High
$1,380.38
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$1,202.26
Median
$1,202.26
Typical High
$1,202.26