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New Hampshire rates for HCPCS L3650

Shoulder Orthosis Figure Of Eight Design Abduction Restrainer Prefabricated Off-The-Shelf(Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.63 / $45.63 / $841.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.83 / $35.40 / $45.63
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.77 / $60.77 / $60.77
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.03 / $81.03 / $96.05
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.58 / $39.58 / $41.73
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.70 / $46.70 / $69.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.09 / $34.09 / $49.79
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.61 / $65.61 / $202.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.95 / $40.43 / $48.01
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.95 / $63.54 / $93.40