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Utah rates for HCPCS L1840

Knee Orthosis Derotation Medial-Lateral Anterior Cruciate Ligament Custom Fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$333.63 / $333.63 / $333.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$333.63 / $471.67 / $3,985.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$732.96 / $732.96 / $732.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$535.05 / $535.05 / $1,313.63
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$468.85 / $756.22 / $983.08
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$907.05 / $1,011.60 / $1,011.60
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$576.04 / $725.12 / $1,087.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$397.05 / $516.79 / $661.70