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New Hampshire rates for HCPCS L3650

Shoulder orthosis (SO), figure of eight design abduction restrainer, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.71 / $45.71 / $831.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $39.81 / $54.95
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $60.26 / $60.26
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $89.13 / $100.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $39.81 / $40.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.77 / $46.77 / $69.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.88 / $33.88 / $50.12
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $70.79 / $123.03
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.95 / $33.88 / $43.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.92 / $40.74 / $70.79
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.10 / $63.10 / $102.33