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Utah rates for HCPCS L2820

Addition to lower extremity orthosis, soft interface for molded plastic, below knee section

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
$42.66 / $58.88 / $165.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.44 / $72.44 / $72.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.48 / $52.48 / $77.62
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.88 / $95.50 / $123.03
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.72 / $114.82 / $199.53
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.18 / $93.33 / $109.65
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $131.83 / $131.83
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $131.83 / $131.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.74 / $48.98 / $100.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.02 / $48.98 / $70.79