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Missouri 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
$361.64 / $361.64 / $481.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$361.64 / $374.79 / $572.04
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$690.81 / $725.35 / $3,188.78
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.41 / $382.93 / $558.89
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
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$361.64 / $559.15 / $3,518.89
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$270.27 / $344.63 / $839.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.01 / $344.63 / $555.15