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New Hampshire rates for HCPCS L1900

Ankle Foot Orthosis Spring Wire Dorsiflexion Assist Calf Band Custom-Fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$201.48 / $201.48 / $241.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.08 / $156.34 / $201.48
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$357.83 / $357.83 / $424.17
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$185.10 / $185.10 / $193.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$189.91 / $189.91 / $189.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.63 / $138.63 / $202.45
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$289.70 / $289.70 / $894.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.01 / $178.51 / $285.10
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$267.99 / $294.79 / $375.19