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Utah rates for HCPCS L1980

Ankle Foot Orthosis Single Upright Free Plantar Dorsiflexion Solid Stirrup Calf Band/Cuff (Single Bar Bk Orthosis) Custom-Fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$133.16 / $133.16 / $133.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.16 / $188.26 / $1,590.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$273.20 / $273.20 / $273.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.44 / $273.20 / $291.25
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$201.77 / $325.45 / $423.08
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$390.36 / $435.35 / $435.35
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$247.91 / $312.06 / $468.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.47 / $204.43 / $264.11