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South Carolina 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
$323.64 / $323.64 / $323.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.64 / $323.64 / $572.59
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.00 / $479.08 / $693.73
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$291.24 / $408.60 / $451.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$298.27 / $393.23 / $408.60
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$220.00 / $469.00 / $1,026.96
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$368.00 / $368.00 / $395.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$441.86 / $441.86 / $441.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$220.92 / $323.32 / $439.79