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Utah rates for HCPCS L1040

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.18 / $28.18 / $28.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.18 / $53.70 / $512.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.07 / $66.07 / $66.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $48.98 / $70.79
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $64.57 / $83.18
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.07 / $77.62 / $131.83
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $63.10 / $93.33
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $87.10 / $109.65
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $89.13 / $131.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.31 / $43.65 / $58.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.67 / $43.65 / $63.10