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Indiana 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
$376.83 / $376.83 / $761.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$348.54 / $376.83 / $408.94
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$601.47 / $681.42 / $761.36
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.41 / $382.93 / $528.44
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$555.82 / $817.39 / $1,065.90
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$647.16 / $837.50 / $1,027.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$408.60 / $408.60 / $761.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$298.27 / $408.60 / $759.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$217.48 / $362.18 / $508.71