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Utah rates for HCPCS L0160

Cervical Semi-Rigid Wire Frame Occipital/ Mandibular Support Prefabricated Off-The-Shelf (Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.83 / $56.83 / $56.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.83 / $105.06 / $574.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.82 / $121.82 / $121.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.93 / $121.82 / $129.86
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.86 / $128.81 / $167.45
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$154.50 / $172.31 / $172.31
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.12 / $123.52 / $185.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.63 / $87.24 / $105.87