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Illinois 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
$391.33 / $391.33 / $391.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.66 / $391.33 / $585.54
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,004.99 / $3,666.06 / $7,996.14
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$442.39 / $578.63 / $578.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$408.60 / $408.60 / $759.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$298.27 / $408.60 / $882.75
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$609.09 / $799.43 / $959.00
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$989.77 / $989.77 / $989.77
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$401.69 / $573.85 / $602.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$271.86 / $379.84 / $672.58