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Utah rates for HCPCS L1930

Ankle Foot Orthosis Plastic Or Other Material Prefabricated Includes Fitting And Adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.84 / $85.84 / $85.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.84 / $160.06 / $1,025.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$175.81 / $175.81 / $191.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.34 / $175.81 / $191.33
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.65 / $212.35 / $276.05
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$254.70 / $284.06 / $284.06
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.75 / $203.62 / $305.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.15 / $131.77 / $159.91