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Utah rates for HCPCS L2128

Knee Ankle Foot Orthosis Fracture Orthosis Femoral Fracture Cast Orthosis Custom-Fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$622.17 / $622.17 / $622.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$622.17 / $827.90 / $6,994.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,207.09 / $1,207.09 / $1,207.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$881.18 / $1,207.09 / $1,243.31
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$874.36 / $1,410.26 / $1,833.33
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,691.55 / $1,886.53 / $1,886.53
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,074.25 / $1,352.26 / $2,028.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$754.61 / $963.76 / $1,234.00