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Utah rates for HCPCS L0113

Cranial cervical orthosis, torticollis type, with or without joint, with or without soft interface material, prefabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.89 / $194.98 / $218.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $181.97 / $302.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.55 / $190.55 / $190.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $141.25 / $199.53
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $251.19 / $323.59
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$257.04 / $302.00 / $524.81
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $245.47 / $371.54
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $346.74 / $354.81
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $354.81 / $426.58
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.82 / $151.36 / $199.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $154.88 / $229.09