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Virginia 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
$380.44 / $380.44 / $1,496.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$314.91 / $380.44 / $408.94
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$769.43 / $769.43 / $817.13
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$382.93 / $382.93 / $509.87
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$413.00 / $413.00 / $525.98
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 / $408.60
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$538.60 / $692.49 / $923.32
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$210.61 / $469.00 / $875.86
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$368.00 / $961.79 / $1,281.63
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$421.55 / $580.67 / $961.79
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$421.55 / $580.67 / $961.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$296.20 / $383.86 / $578.24