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New Hampshire rates for HCPCS L4110

Replace leather cuff KAFO-AFO, calf or distal thigh

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.36 / $64.36 / $77.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.77 / $50.95 / $64.36
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.31 / $114.31 / $135.50
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.20 / $57.20 / $60.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.81 / $61.81 / $61.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.12 / $45.12 / $65.89
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.55 / $92.55 / $285.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.02 / $57.02 / $91.07
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.61 / $94.17 / $119.85