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New Hampshire rates for HCPCS L3984

Upper extremity fracture orthosis, wrist, prefabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$268.27 / $268.27 / $321.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.16 / $208.17 / $268.27
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$357.34 / $357.34 / $357.34
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$476.45 / $476.45 / $564.78
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$230.17 / $230.17 / $242.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$225.12 / $237.10 / $237.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.08 / $173.08 / $252.76
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$385.76 / $385.76 / $1,190.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.46 / $237.70 / $341.01
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$311.29 / $342.42 / $435.81