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New Hampshire rates for HCPCS L3702

Elbow orthosis (EO), without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$174.00 / $174.01 / $383.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.18 / $135.03 / $195.36
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$309.02 / $309.02 / $366.32
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$171.10 / $171.10 / $180.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$176.75 / $176.75 / $180.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.03 / $129.03 / $180.09
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$250.21 / $250.21 / $772.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.78 / $154.18 / $183.06
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$231.46 / $271.77 / $408.30