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Utah rates for HCPCS L1950

Ankle Foot Orthosis Spiral (Institute Of Rehabilitative Medicine Type) Plastic Custom-Fabricated. (Rvsd 1/1/04)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$270.27 / $270.27 / $270.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$270.27 / $376.01 / $3,228.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$524.34 / $524.34 / $524.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$382.77 / $524.34 / $558.97
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$410.92 / $662.78 / $861.61
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.98 / $886.61 / $886.61
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$504.86 / $635.52 / $953.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$327.79 / $418.64 / $536.02