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New Hampshire rates for HCPCS L2114

Ankle Foot Orthosis Fracture Orthosis Tibial Fracture Orthosis Semi-Rigid Prefabricated Includes Fitting And Adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$433.12 / $433.12 / $519.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.66 / $348.75 / $466.89
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$769.21 / $769.21 / $911.82
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$382.93 / $382.93 / $417.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$408.60 / $408.60 / $408.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$298.27 / $298.27 / $435.59
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$622.79 / $622.79 / $1,922.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$255.83 / $383.75 / $499.22
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$502.57 / $552.83 / $703.60