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Utah rates for HCPCS L4080

Replace metal bands KAFO, proximal thigh

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.31 / $36.31 / $36.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.31 / $63.10 / $562.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.11 / $85.11 / $85.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $61.66 / $87.10
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $83.18 / $107.15
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.11 / $100.00 / $173.78
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $81.28 / $123.03
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $114.82 / $134.90
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.18 / $117.49 / $165.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.86 / $56.23 / $74.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $56.23 / $81.28