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New Hampshire rates for HCPCS L3904

Wrist-hand-finger orthosis (WHFO), external powered, electric, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,912.80 / $1,912.80 / $2,295.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,328.64 / $1,484.29 / $1,912.80
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,397.13 / $3,397.13 / $4,026.96
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,966.25 / $1,966.25 / $2,060.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,017.28 / $2,017.28 / $2,017.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,472.61 / $1,472.61 / $2,077.80
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,750.51 / $2,750.51 / $8,489.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,129.85 / $1,694.79 / $2,855.44
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,544.34 / $2,798.77 / $3,562.08