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Utah rates for HCPCS L2375

Addition to lower extremity, torsion control, ankle joint and half solid stirrup

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.74 / $40.74 / $40.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.74 / $75.86 / $741.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.71 / $104.71 / $104.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $75.86 / $107.15
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.54 / $93.33 / $120.23
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.50 / $112.20 / $194.98
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $91.20 / $134.90
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $125.89 / $128.82
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $128.82 / $154.88
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.48 / $63.10 / $85.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $63.10 / $91.20