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New Hampshire rates for HCPCS L3720

Elbow orthosis (EO), double upright with forearm/arm cuffs, free motion, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$406.01 / $406.01 / $487.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$315.05 / $384.57 / $437.67
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$721.07 / $721.07 / $854.76
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$460.15 / $463.84 / $463.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$450.57 / $450.57 / $450.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$328.92 / $328.92 / $480.33
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$583.80 / $583.80 / $1,801.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$270.68 / $359.73 / $471.19
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$540.05 / $594.07 / $756.08