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Utah rates for HCPCS L1720

Legg Perthes orthosis, trilateral, (Tachdijan type), custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$478.13 / $478.13 / $478.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.13 / $675.95 / $5,710.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,149.77 / $1,149.77 / $1,149.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$839.33 / $1,149.77 / $1,184.26
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$671.91 / $1,083.74 / $1,408.86
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,299.90 / $1,449.73 / $1,449.73
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$825.53 / $1,039.16 / $1,558.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$579.89 / $740.61 / $869.84