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New Hampshire rates for HCPCS L1940

Ankle-foot orthosis (AFO), plastic or other material, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $416.87 / $501.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $331.13 / $501.19
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $812.83 / $933.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $346.74 / $363.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$371.54 / $371.54 / $549.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $269.15 / $371.54
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $645.65 / $1,122.02
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.82 / $288.40 / $371.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $371.54 / $645.65
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $660.69 / $1,071.52