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Utah rates for HCPCS L1030

Addition to cervical-thoracic-lumbar-sacral orthosis (CTLSO) or scoliosis orthosis, lumbar bolster pad

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.91 / $22.91 / $22.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.91 / $43.65 / $323.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.48 / $52.48 / $52.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.90 / $38.90 / $56.23
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.67 / $52.48 / $67.61
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.70 / $63.10 / $109.65
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $51.29 / $77.62
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $72.44 / $75.86
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.48 / $72.44 / $89.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.51 / $35.48 / $43.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.18 / $35.48 / $51.29