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New Hampshire rates for HCPCS L3995

Addition to upper extremity orthosis, sock, fracture or equal, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.07 / $27.07 / $32.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.18 / $21.00 / $27.07
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.06 / $48.06 / $56.97
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.33 / $22.33 / $23.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.97 / $29.97 / $29.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $21.88 / $29.97
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.90 / $38.90 / $120.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.98 / $23.98 / $38.90
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.41 / $34.54 / $43.97