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Utah rates for HCPCS L1200

Thoracic-Lumbar-Sacral-Orthosis (Tlso) Inclusive Of Furnishing Initial Orthosis Only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$568.52 / $568.52 / $568.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$568.52 / $803.73 / $6,790.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,184.20 / $1,184.20 / $1,184.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$864.47 / $1,184.20 / $2,499.75
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$958.08 / $1,545.30 / $2,008.89
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,853.53 / $2,067.17 / $2,067.17
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,177.13 / $1,481.75 / $2,222.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$689.52 / $880.62 / $1,127.56