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Utah rates for HCPCS L4394

Replace Soft Interface Material, Foot Drop Splint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.94 / $5.94 / $5.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.94 / $6.77 / $57.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.40 / $13.40 / $13.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.77 / $13.40 / $13.80
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.29 / $15.04 / $20.30
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.98 / $20.05 / $20.05
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.43 / $14.37 / $21.56
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.67 / $9.19 / $9.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.07 / $9.19 / $11.06