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Utah rates for HCPCS L2116

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$257.04 / $257.04 / $257.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $446.68 / $776.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $501.19 / $501.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $363.08 / $537.03
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $588.84 / $758.58
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$602.56 / $707.95 / $1,202.26
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $575.44 / $851.14
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $794.33 / $812.83
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $812.83 / $977.24
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$331.13 / $398.11 / $562.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $398.11 / $575.44