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New Hampshire rates for HCPCS L4100

Replace leather cuff KAFO, proximal thigh

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.13 / $74.13 / $89.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.54 / $64.57 / $138.04
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.90 / $144.54 / $165.96
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.18 / $69.18 / $69.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.13 / $74.13 / $97.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.70 / $53.70 / $74.13
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $117.49 / $204.17
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.31 / $61.66 / $79.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $66.07 / $117.49
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.23 / $120.23 / $190.55