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New Hampshire rates for HCPCS L1990

Ankle-foot orthosis (AFO), double upright free plantar dorsiflexion, solid stirrup, calf band/cuff (double bar 'BK' orthosis), custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$354.81 / $354.81 / $426.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $309.03 / $562.34
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.65 / $691.83 / $794.33
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $309.03 / $316.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.23 / $316.23 / $467.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $229.09 / $316.23
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $562.34 / $977.24
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$154.88 / $263.03 / $398.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $316.23 / $562.34
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.44 / $575.44 / $912.01