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Utah rates for HCPCS L4210

Repair of orthotic device, repair or replace minor parts

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.95 / $19.95 / $19.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.95 / $19.95 / $138.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.88 / $117.49 / $117.49
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.77 / $16.98 / $44.67
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.18 / $13.18 / $13.18
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.18 / $13.18 / $13.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $51.29 / $51.29