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Utah rates for HCPCS L1650

Hip orthosis (HO), abduction control of hip joints, static, adjustable, (Ilfled type), prefabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $83.18 / $83.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $154.88 / $467.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.55 / $190.55 / $190.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $138.04 / $204.17
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $213.80 / $281.84
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.78 / $257.04 / $446.68
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $208.93 / $281.84
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $295.12 / $302.00
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $302.00 / $316.23
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.65 / $128.82 / $151.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $128.82 / $186.21