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Utah rates for HCPCS L4370

Pneumatic Full Leg Splint Prefabricated Off-The-Shelf (Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$68.50 / $68.50 / $68.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.50 / $94.98 / $613.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$150.11 / $150.11 / $150.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.58 / $150.11 / $160.02
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.58 / $170.30 / $221.39
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$204.27 / $227.81 / $227.81
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.72 / $163.30 / $244.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.08 / $106.10 / $127.61