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New Hampshire rates for HCPCS L3901

Wrist-hand-finger orthosis (WHFO), dynamic flexor hinge, reciprocal wrist extension/ flexion, finger flexion/extension, cable driven, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$997.54 / $997.54 / $1,197.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$729.34 / $852.96 / $997.54
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,771.62 / $1,771.62 / $2,100.08
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,079.00 / $1,079.00 / $1,130.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,107.01 / $1,107.01 / $1,107.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$808.12 / $1,107.01 / $1,609.82
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,434.41 / $1,434.41 / $4,427.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$589.23 / $883.84 / $1,049.45
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,326.89 / $1,459.58 / $1,857.65