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New Hampshire rates for HCPCS L3919

Hand orthosis (HO), without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.18 / $194.98 / $446.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $151.36 / $251.19
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $186.21 / $186.21
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$295.12 / $316.23 / $363.08
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $154.88 / $158.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.83 / $177.83 / $177.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $128.82 / $177.83
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $251.19 / $446.68
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.28 / $131.83 / $173.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $144.54 / $251.19
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$257.04 / $257.04 / $416.87