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Utah rates for HCPCS L1000

Cervical-thoracic-lumbar-sacral orthosis (CTLSO) (Milwaukee), inclusive of furnishing initial orthotic, including model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $741.31 / $741.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $1,348.96 / $13,182.57
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,513.56 / $1,513.56 / $1,513.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,096.48 / $1,584.89
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $1,949.84 / $2,511.89
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $2,344.23 / $4,073.80
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $1,905.46 / $2,884.03
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398.83 / $2,691.53 / $2,818.38
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $2,691.53 / $3,388.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.99 / $1,148.15 / $1,621.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,148.15 / $1,621.81