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New Hampshire rates for HCPCS L3760

Elbow orthosis (EO), with adjustable position locking joint(s), prefabricated, item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.00 / $302.00 / $363.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.78 / $295.12 / $512.86
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $588.84 / $660.69
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $295.12 / $302.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$323.59 / $338.84 / $389.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $245.47 / $338.84
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $467.74 / $812.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$151.36 / $239.88 / $288.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $269.15 / $467.74
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $416.87 / $676.08