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New Hampshire rates for HCPCS L3761

Elbow orthosis (EO), with adjustable position locking joint(s), prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$323.35 / $323.35 / $388.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$220.27 / $315.68 / $369.55
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$535.20 / $575.00 / $575.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$535.20 / $535.20 / $634.42
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$301.51 / $301.51 / $301.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$375.73 / $375.73 / $383.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$274.27 / $274.27 / $383.66
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$433.34 / $433.34 / $1,337.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$178.01 / $267.01 / $366.46
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$353.53 / $388.88 / $494.94