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Utah rates for HCPCS L1850

Knee Orthosis Swedish Type Prefabricated Off- The- Shelf (Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.44 / $104.44 / $104.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.44 / $104.44 / $1,247.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$214.95 / $214.95 / $214.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.91 / $214.95 / $229.14
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.18 / $148.69 / $193.72
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$198.18 / $198.18 / $236.51
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.88 / $177.59 / $224.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.29 / $161.78 / $161.78