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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
$195.06 / $468.16 / $468.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$195.06 / $304.38 / $1,909.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$419.48 / $419.48 / $419.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$306.22 / $419.48 / $491.90
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$310.21 / $500.34 / $650.44
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$600.15 / $669.32 / $669.32
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$381.14 / $479.77 / $719.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$236.58 / $302.14 / $386.87