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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
$74.87 / $74.87 / $89.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.46 / $62.67 / $74.87
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$132.99 / $132.99 / $157.65
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.81 / $68.81 / $74.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$73.43 / $73.43 / $73.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.60 / $53.60 / $78.27
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.68 / $107.68 / $332.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.23 / $66.34 / $76.79
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.60 / $109.56 / $139.44