go back

New Hampshire rates for HCPCS L3960

Shoulder-elbow-wrist-hand orthosis (SEWHO), abduction positioning, airplane design, prefabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$542.03 / $542.03 / $650.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$333.74 / $420.60 / $559.61
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$721.96 / $721.96 / $721.96
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$962.61 / $962.61 / $1,141.08
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$492.70 / $492.70 / $517.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$510.00 / $510.00 / $516.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$372.30 / $372.30 / $543.69
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$779.39 / $779.39 / $2,405.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$320.16 / $480.24 / $570.23
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$628.92 / $691.82 / $880.50