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Utah rates for HCPCS L1906

Ankle foot orthosis (AFO), multiligamentous ankle support, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.66 / $42.66 / $42.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $100.00 / $407.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.10 / $87.10 / $87.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $63.10 / $97.72
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $131.83 / $169.82
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.90 / $158.49 / $275.42
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $128.82 / $151.36
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $181.97 / $186.21
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $186.21 / $186.21
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $67.61 / $120.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.48 / $67.61 / $97.72