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New Hampshire rates for HCPCS L3100

Hallus-Valgus Night Dynamic Splint Prefabricated Off-The-Shelf (Revised 01/01/14) (Special Coverage Instructions Apply. See Mcm: 2323)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.63 / $28.63 / $34.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.92 / $22.21 / $30.86
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.84 / $50.84 / $60.27
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.25 / $27.25 / $29.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.89 / $34.89 / $34.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.47 / $25.47 / $34.89
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.17 / $41.17 / $127.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.91 / $25.37 / $30.12
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.57 / $35.47 / $54.28