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Washington 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
$367.77 / $834.84 / $871.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$294.35 / $367.77 / $834.84
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$477.20 / $1,233.96 / $2,802.95
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$397.84 / $495.15 / $3,204.58
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 / $239.76 / $328.44
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$330.78 / $562.80 / $1,493.32
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.14 / $562.80 / $1,115.47
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$375.99 / $417.77 / $459.54
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$432.58 / $525.62 / $544.98
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$490.48 / $544.98 / $544.98
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$477.20 / $612.04 / $1,064.42
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$518.72 / $532.21 / $532.21
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$432.92 / $463.23 / $599.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$242.45 / $262.64 / $500.30
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$319.70 / $355.96 / $355.96