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Utah rates for HCPCS L0112

Cranial cervical orthosis, congenital torticollis type, with or without soft interface material, adjustable range of motion joint, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$485.19 / $485.19 / $485.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$485.19 / $485.19 / $910.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$941.33 / $941.33 / $941.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$687.17 / $941.33 / $969.57
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$771.63 / $1,244.57 / $1,617.94
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,492.81 / $1,664.87 / $1,664.87
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$948.04 / $1,193.38 / $1,790.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$577.41 / $751.55 / $962.29