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Utah rates for HCPCS L1920

Ankle Foot Orthosis Single Upright With Static Or Adjustable Stop (Phelps Or Perlstein Type) Custom-Fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$126.85 / $126.85 / $126.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.85 / $140.26 / $1,185.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$246.11 / $246.11 / $246.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$179.66 / $246.10 / $266.52
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$224.21 / $361.63 / $470.11
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$433.76 / $483.76 / $483.76
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.47 / $346.76 / $520.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.85 / $194.74 / $242.23