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Utah rates for HCPCS L1830

Knee orthosis (KO), immobilizer, canvas longitudinal, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.61 / $74.13 / $83.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.62 / $58.88 / $269.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.61 / $67.61 / $67.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $48.98 / $70.79
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $45.71 / $61.66
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.54 / $69.18 / $123.03
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $44.67 / $70.79
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $64.57 / $91.20
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $64.57 / $77.62
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.74 / $48.98 / $89.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.99 / $47.86 / $63.10