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Utah rates for HCPCS L1907

Ankle orthosis (AO), supramalleolar with straps, with or without interface/pads, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.98 / $194.98 / $194.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $363.08 / $2,884.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $416.87 / $416.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $309.03 / $489.78
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $501.19 / $645.65
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$512.86 / $602.56 / $1,047.13
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $489.78 / $707.95
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $691.83 / $691.83
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $691.83 / $812.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.19 / $302.00 / $398.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $302.00 / $436.52