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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

Facilitymedian $1,047 · 10th–90th $575–$1,2300%20%40%10th90th$1,047Professionalmedian $692 · 10th–90th $447–$9550%20%10th90th$692$500.0$1.0K$2.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$575.44 / $575.44 / $691.83
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$436.52 / $575.44 / $776.25
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,047.13 / $1,096.48 / $1,258.93
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$501.19 / $501.19 / $501.19
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$575.44 / $575.44 / $575.44
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$426.58 / $426.58 / $575.44
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$891.25 / $891.25 / $1,659.59
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$251.19 / $398.11 / $537.03
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$371.54 / $776.25 / $891.25
Well Sense
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$977.24 / $977.24 / $1,445.44