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Utah rates for HCPCS L2190

Addition to lower extremity fracture orthosis, waist belt

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.90 / $30.90 / $30.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.90 / $57.54 / $426.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.66 / $61.66 / $61.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $44.67 / $63.10
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.71 / $74.13 / $97.72
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.86 / $89.13 / $154.88
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $72.44 / $104.71
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $102.33 / $104.71
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $104.71 / $120.23
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.51 / $48.98 / $56.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.02 / $48.98 / $70.79