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Utah rates for HCPCS L1940

Ankle-Foot Orthotic (Afo), Plastic Or Other Material, Custom Fab

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$179.44 / $179.44 / $179.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$179.44 / $331.01 / $2,143.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$372.88 / $372.88 / $372.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$272.20 / $372.88 / $397.51
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$252.17 / $406.73 / $528.74
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$487.86 / $544.10 / $544.10
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.83 / $390.01 / $585.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$250.97 / $277.95 / $326.45