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South Carolina 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
$323.59 / $323.59 / $323.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $380.19 / $575.44
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $660.69 / $776.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.40 / $407.38 / $1,202.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $295.12 / $891.25
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $467.74 / $512.86
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$323.59 / $549.54 / $1,174.90
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $208.93 / $208.93
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $446.68
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$323.59 / $407.38 / $891.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $323.59 / $436.52