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Michigan 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
$434.81 / $434.81 / $434.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$373.86 / $434.81 / $434.81
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,152.36 / $2,295.96 / $4,181.68
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$723.29 / $761.36 / $1,027.83
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$425.04 / $494.88 / $500.13
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$609.09 / $609.09 / $609.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$408.60 / $408.60 / $408.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$408.60 / $408.60 / $882.75
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$434.81 / $550.19 / $550.19
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$408.94 / $550.19 / $799.42
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$461.99 / $563.41 / $647.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$255.43 / $357.53 / $544.91