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New Hampshire rates for HCPCS L1930

Ankle-foot orthosis (AFO), plastic or other material, prefabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.19 / $173.19 / $207.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.68 / $134.38 / $184.08
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$307.57 / $307.57 / $364.59
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.00 / $125.00 / $170.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$175.81 / $175.81 / $191.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.34 / $128.34 / $187.43
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$249.02 / $249.02 / $768.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.30 / $153.44 / $182.20
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.95 / $241.14 / $354.48