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Utah rates for HCPCS L4205

Repair of orthotic device, labor component, per 15 minutes

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.02 / $12.02 / $12.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.91 / $15.14 / $104.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.39 / $22.39 / $22.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.22 / $16.22 / $23.44
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.20 / $22.91 / $34.67
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.92 / $31.62 / $48.98
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.49 / $20.89 / $33.11
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.84 / $28.84 / $30.20
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.99 / $30.20 / $39.81
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.75 / $13.80 / $14.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.22 / $14.13 / $20.42