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New Hampshire rates for HCPCS L4397

Static Or Dynamic Ankle Foot Orthosis Including Soft Interface Material Adjustable For Fit For Positioning May Be Used For Minimal Ambulation Prefabricated Off-The-Shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.02 / $121.02 / $145.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.20 / $112.90 / $136.02
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$206.16 / $206.16 / $206.16
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$206.16 / $206.16 / $244.38
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.31 / $115.83 / $115.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.02 / $127.07 / $127.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.76 / $92.76 / $127.07
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.92 / $166.92 / $515.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.56 / $101.93 / $150.53
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.85 / $154.88 / $220.14