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Utah rates for HCPCS L1100

Addition to cervical-thoracic-lumbar-sacral orthosis (CTLSO) or scoliosis orthosis, ring flange, plastic or leather

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.54 / $57.54 / $57.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.54 / $100.00 / $1,047.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.20 / $112.20 / $112.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $81.28 / $114.82
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $131.83 / $169.82
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$131.83 / $158.49 / $269.15
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $128.82 / $190.55
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $177.83 / $208.93
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $181.97 / $251.19
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.13 / $89.13 / $120.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.18 / $89.13 / $128.82