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Utah 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
$208.93 / $208.93 / $208.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $371.54 / $3,801.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.38 / $407.38 / $407.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $295.12 / $436.52
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $478.63 / $630.96
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $575.44 / $1,000.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $467.74 / $707.95
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $660.69 / $676.08
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $676.08 / $812.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$269.15 / $323.59 / $436.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $323.59 / $467.74