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New Hampshire rates for HCPCS L3915

Wrist Hand Orthosis Includes One Or More Non- Torsion Joint(S) Elastic Bands Turnblocks May Include Soft Interface Straps Prefabricated Itemthat Has Been Trimmed Bent Molded Assembled Orotherwise Customized To Fit A Specific Patient By An Individual With Expertise (Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$320.33 / $320.33 / $384.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.13 / $248.57 / $320.33
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$568.90 / $568.90 / $674.37
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.64 / $316.64 / $332.28
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$325.37 / $325.37 / $325.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$237.52 / $325.37 / $465.03
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$460.61 / $460.61 / $1,421.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$195.46 / $283.82 / $460.61
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.69 / $408.86 / $520.37