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Utah rates for HCPCS L1990

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$161.74 / $161.74 / $161.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.74 / $224.26 / $1,931.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$313.79 / $313.79 / $313.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.07 / $313.79 / $334.52
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$227.29 / $366.60 / $476.58
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$439.72 / $490.41 / $490.41
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$279.25 / $351.53 / $527.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$196.16 / $250.53 / $320.77