go back

New Hampshire rates for HCPCS L3905

Wrist-hand orthosis (WHO), includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$597.63 / $597.63 / $717.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.81 / $463.74 / $644.23
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,061.39 / $1,061.39 / $1,258.17
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$619.99 / $635.91 / $635.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$607.01 / $607.01 / $607.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$443.12 / $607.01 / $860.13
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$859.34 / $859.34 / $2,652.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$353.00 / $529.51 / $628.74
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.94 / $874.43 / $1,112.92