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New Hampshire rates for HCPCS L3967

Shoulder-elbow-wrist-hand orthosis (SEWHO), abduction positioning (airplane design), thoracic component and support bar, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,195.39 / $1,195.39 / $1,434.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$873.72 / $927.59 / $1,288.61
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,123.00 / $2,123.00 / $2,516.60
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,181.67 / $1,181.67 / $1,240.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,540.39 / $1,540.39 / $1,540.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,124.48 / $1,124.48 / $1,540.39
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,718.89 / $1,718.89 / $5,305.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$706.09 / $1,059.14 / $1,257.59
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,590.05 / $1,749.06 / $2,226.07