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New Hampshire rates for HCPCS L3762

Elbow Orthosis Rigid Without Joints Includes Soft Interface Material Prefabricated Off-The- Shelf (Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.80 / $64.80 / $77.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.36 / $50.28 / $69.84
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.31 / $86.31 / $115.08
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$115.08 / $115.08 / $136.41
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.01 / $64.01 / $67.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.81 / $65.81 / $383.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.04 / $48.04 / $70.16
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.17 / $93.17 / $287.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.27 / $57.41 / $68.83
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.19 / $90.23 / $132.63