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New Hampshire rates for HCPCS L1990

Ankle Foot Orthosis 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
$358.27 / $358.27 / $429.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$206.67 / $278.00 / $378.16
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$636.28 / $636.28 / $754.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$308.99 / $308.99 / $320.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$313.79 / $313.79 / $313.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.07 / $229.07 / $334.52
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$515.16 / $515.16 / $1,590.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$211.62 / $317.43 / $376.92
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$476.54 / $524.19 / $667.16