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New Mexico 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
$362.22 / $362.22 / $362.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$362.22 / $556.27 / $2,515.58
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$442.57 / $590.09 / $703.10
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 / $408.60 / $408.60
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$590.95 / $738.69 / $1,108.03
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$210.61 / $210.61 / $555.15
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$298.27 / $408.60 / $783.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$296.20 / $326.23 / $491.42