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Utah rates for HCPCS L1900

Ankle Foot Orthosis Spring Wire Dorsiflexion Assist Calf Band Custom-Fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.89 / $97.89 / $97.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.89 / $117.40 / $991.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$189.91 / $189.91 / $189.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.63 / $189.91 / $202.45
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.00 / $241.95 / $314.53
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$290.20 / $323.66 / $323.66
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$184.30 / $232.00 / $348.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.90 / $151.62 / $178.08