go back

Utah rates for HCPCS L1210

Addition to thoracic-lumbar-sacral orthosis (TLSO), (low profile), lateral thoracic extension

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$94.94 / $94.94 / $94.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.94 / $131.63 / $1,134.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.69 / $190.69 / $190.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$139.19 / $190.69 / $203.28
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.89 / $286.93 / $373.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$344.16 / $383.83 / $383.83
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.57 / $275.13 / $412.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.15 / $147.07 / $188.30