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Utah rates for HCPCS L2128

Knee-ankle-foot orthosis (KAFO), fracture orthosis, femoral fracture cast orthosis, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$616.60 / $616.60 / $616.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $1,047.13 / $10,471.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,202.26 / $1,202.26 / $1,202.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $891.25 / $1,230.27
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $1,412.54 / $1,819.70
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,445.44 / $1,698.24 / $2,951.21
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,380.38 / $2,238.72
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $1,949.84 / $2,570.40
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $1,949.84 / $2,884.03
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.33 / $954.99 / $1,258.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $954.99 / $1,380.38