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New Hampshire rates for HCPCS L3933

Finger orthosis (FO), without joints, may include soft interface, custom fabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.58 / $128.58 / $551.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.97 / $128.58 / $209.35
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$228.32 / $228.32 / $270.64
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.31 / $127.31 / $133.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$130.59 / $130.59 / $130.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.33 / $130.59 / $189.77
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$184.87 / $184.87 / $570.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.94 / $113.91 / $136.58
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$171.01 / $200.81 / $301.66