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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
$537.03 / $537.03 / $645.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $467.74 / $794.33
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$977.24 / $1,047.13 / $1,202.26
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $489.78 / $489.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$512.86 / $512.86 / $707.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $371.54 / $512.86
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $851.14 / $1,479.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.19 / $416.87 / $562.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $478.63 / $851.14
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $758.58 / $1,202.26