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Utah rates for HCPCS L2010

Knee Ankle Foot Orthosis Single Upright Free Ankle Solid Stirrup Thigh And Calf Bands/Cuffs (Single Bar Ak Orthosis) Without Knee Joint Custom-Fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$335.49 / $335.49 / $335.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$335.49 / $474.30 / $4,007.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$740.83 / $740.83 / $740.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$540.80 / $740.83 / $763.05
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$551.64 / $889.75 / $1,156.67
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,067.22 / $1,190.23 / $1,190.23
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$677.75 / $853.16 / $1,279.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$406.90 / $519.67 / $665.40