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Utah rates for HCPCS L1110

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$92.67 / $92.67 / $92.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.67 / $129.63 / $1,106.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$225.30 / $225.30 / $225.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$164.47 / $225.30 / $232.06
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.23 / $210.05 / $273.06
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.95 / $280.98 / $280.98
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.00 / $201.41 / $302.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.39 / $142.27 / $172.64