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Utah rates for HCPCS L1690

Combination Bilateral Lumbo-Sacral Hip Femur Orthosis Providing Adduction And Internal Rotation Control Prefabricated Includes Fitting And Adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$670.35 / $670.35 / $670.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$670.35 / $776.58 / $6,561.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,300.55 / $1,300.55 / $1,300.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$949.40 / $949.40 / $2,701.13
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,066.10 / $1,719.52 / $2,235.37
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,062.48 / $2,300.21 / $2,300.21
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,309.82 / $1,648.80 / $2,473.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$797.78 / $1,038.36 / $1,219.55