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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
$173.78 / $331.13 / $416.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $162.18 / $269.15
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.23 / $338.84 / $380.19
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $169.82 / $177.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.83 / $177.83 / $181.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $128.82 / $177.83
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $269.15 / $467.74
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.10 / $141.25 / $186.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.15 / $154.88 / $269.15
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$275.42 / $275.42 / $446.68