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New Hampshire rates for HCPCS L3917

Hand Orthosis Metacarpal Fracture Orthosis Pre- Fabricated Item That Has Been Trimmed Bent Moldemolded Assembled Or Otherwise 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
$63.67 / $63.67 / $76.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.55 / $49.41 / $63.67
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$113.11 / $113.11 / $134.08
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.92 / $62.92 / $66.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.66 / $64.66 / $64.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.20 / $64.66 / $92.03
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.57 / $91.57 / $282.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.61 / $56.42 / $66.97
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.89 / $81.28 / $103.45