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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
$169.29 / $169.29 / $169.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.29 / $206.00 / $1,865.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$328.44 / $328.44 / $328.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.76 / $328.44 / $350.14
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$237.90 / $383.72 / $498.83
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$460.25 / $513.29 / $513.29
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.29 / $367.93 / $551.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$205.32 / $262.22 / $315.37