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New Hampshire rates for HCPCS L3740

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$884.55 / $884.55 / $1,061.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$484.89 / $686.39 / $940.66
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,570.95 / $1,570.95 / $1,862.20
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$713.17 / $713.17 / $751.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$736.22 / $736.22 / $736.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.44 / $537.44 / $784.84
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,271.92 / $1,271.92 / $3,925.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$522.48 / $783.73 / $905.34
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,176.58 / $1,294.25 / $1,647.23