go back

Utah rates for HCPCS L4000

Replace girdle for spinal orthosis (cervical-thoracic-lumbar-sacral orthosis (CTLSO) or spinal orthosis SO)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$462.65 / $462.65 / $462.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$462.65 / $654.05 / $5,526.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$897.58 / $897.58 / $897.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.23 / $655.23 / $1,864.21
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$737.35 / $1,189.28 / $1,546.06
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,426.49 / $1,590.91 / $1,590.91
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$905.93 / $1,140.35 / $1,710.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$957.27 / $957.27 / $957.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$550.59 / $716.63 / $1,221.82