go back

New Hampshire rates for HCPCS L3765

Elbow-wrist-hand-finger orthosis (EWHFO), 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
$772.70 / $772.70 / $927.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$564.78 / $599.60 / $832.97
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,372.31 / $1,372.31 / $1,626.74
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$735.52 / $735.52 / $801.53
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$907.46 / $907.46 / $907.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$662.45 / $907.46 / $1,117.80
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,111.10 / $1,111.10 / $3,429.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$471.49 / $684.64 / $1,111.10
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,027.81 / $1,206.79 / $1,813.06