go back

New Hampshire rates for HCPCS L1902

Ankle orthosis (AO), ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.88 / $58.88 / $70.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.65 / $58.88 / $128.82
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $77.62 / $104.71
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.71 / $112.20 / $128.82
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $54.95 / $54.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.54 / $57.54 / $75.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.66 / $42.66 / $57.54
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $91.20 / $158.49
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.54 / $44.67 / $52.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.67 / $51.29 / $91.20
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.28 / $81.28 / $128.82