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Utah rates for HCPCS L2112

Ankle-foot orthosis (AFO), fracture orthosis, tibial fracture orthosis, soft, prefabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.82 / $169.82 / $169.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $295.12 / $2,818.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$331.13 / $331.13 / $331.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.88 / $239.88 / $346.74
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $380.19 / $501.19
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$389.05 / $457.09 / $794.33
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $371.54 / $562.34
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $524.81 / $549.54
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $537.03 / $660.69
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.82 / $257.04 / $323.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $263.03 / $380.19