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Utah 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
$210.61 / $210.61 / $210.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$210.61 / $297.75 / $2,515.58
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 / $408.60 / $435.59
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$298.39 / $481.28 / $625.66
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$577.28 / $643.82 / $643.82
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$366.61 / $461.49 / $692.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$250.64 / $323.32 / $392.35