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New Hampshire rates for HCPCS L3764

Elbow-wrist-hand orthosis (EWHO), includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$572.97 / $572.97 / $687.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$403.55 / $444.62 / $572.97
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,017.61 / $1,017.61 / $1,206.27
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$496.06 / $496.06 / $519.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$579.51 / $579.51 / $579.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$423.04 / $579.51 / $785.28
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$823.92 / $823.92 / $2,543.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.45 / $507.68 / $776.78
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$762.16 / $838.38 / $1,067.02