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New Hampshire rates for HCPCS L3730

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$746.09 / $746.09 / $895.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$408.99 / $578.94 / $804.27
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,325.04 / $1,325.04 / $1,570.70
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$604.33 / $604.33 / $634.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$620.97 / $620.97 / $620.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$453.31 / $453.31 / $661.98
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,072.82 / $1,072.82 / $3,311.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$440.70 / $649.39 / $708.29
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$992.41 / $1,091.65 / $1,389.37