go back

New Hampshire rates for HCPCS L4631

Ankle-foot orthosis (AFO), walking boot type, varus/valgus correction, rocker bottom, anterior tibial shell, soft interface, custom arch support, plastic or other material, includes straps and closures, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,086.14 / $1,086.14 / $1,303.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$771.71 / $921.77 / $1,086.14
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,928.99 / $1,928.99 / $2,286.62
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,041.95 / $1,124.88 / $1,124.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,037.25 / $1,037.25 / $1,037.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$757.19 / $757.19 / $1,037.25
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,573.00 / $1,573.00 / $4,855.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$641.57 / $962.35 / $1,230.96
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,444.74 / $1,589.21 / $2,022.64