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Utah rates for HCPCS L1906

Ankle Foot Orthosis Multiligamentous Ankle Support Prefabricated Off-The-Shelf (Desc Revised 1/1/2017)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.64 / $43.64 / $43.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.64 / $81.37 / $441.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.70 / $86.88 / $86.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.42 / $86.88 / $157.13
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.76 / $131.88 / $171.44
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$158.18 / $176.41 / $176.41
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.45 / $126.46 / $189.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.93 / $67.59 / $79.39