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Wisconsin 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
$384.08 / $384.08 / $384.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$310.54 / $384.08 / $584.04
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$761.36 / $837.50 / $1,385.68
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$708.06 / $708.06 / $936.47
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$547.72 / $1,629.31 / $1,629.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$408.60 / $1,574.11 / $3,178.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$298.27 / $1,103.44 / $1,440.94
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$210.61 / $572.28 / $875.56
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$435.93 / $761.36 / $913.63
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$364.57 / $761.36 / $3,518.89
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$303.32 / $388.05 / $829.03
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $529.49
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$210.61 / $576.12 / $875.56
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$435.93 / $761.36 / $913.63
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$761.36 / $1,170.00 / $1,957.22
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$408.60 / $1,487.04 / $3,518.89
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$298.27 / $408.60 / $4,535.78
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$761.36 / $761.36 / $761.36
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$607.91 / $761.36 / $761.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$271.86 / $379.84 / $728.02