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New Hampshire rates for HCPCS L3763

Elbow-wrist-hand orthosis (EWHO), rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$438.47 / $438.47 / $526.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.18 / $358.89 / $498.08
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$778.73 / $778.73 / $923.11
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$439.23 / $439.23 / $460.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$488.53 / $488.53 / $488.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$356.63 / $488.53 / $676.08
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.51 / $630.51 / $1,946.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$270.70 / $388.50 / $733.55
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$641.54 / $816.52 / $1,206.79