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New Hampshire rates for HCPCS L2114

Ankle-foot orthosis (AFO), fracture orthosis, tibial fracture orthosis, semi-rigid, prefabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $436.52 / $524.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $389.05 / $588.84
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $831.76 / $954.99
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $380.19 / $398.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.38 / $407.38 / $562.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $295.12 / $407.38
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $676.08 / $1,174.90
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$199.53 / $338.84 / $436.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $380.19 / $676.08
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$602.56 / $602.56 / $954.99