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New Hampshire rates for HCPCS L1900

Ankle-foot orthosis (AFO), spring wire, dorsiflexion assist calf band, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$199.53 / $199.53 / $239.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $177.83 / $295.12
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$363.08 / $389.05 / $446.68
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $186.21 / $186.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.55 / $190.55 / $263.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $138.04 / $190.55
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $316.23 / $549.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.33 / $151.36 / $199.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $177.83 / $316.23
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$323.59 / $323.59 / $512.86