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Utah rates for HCPCS L2387

Addition To Lower Extremity Polycentric Knee Joint For Custom Fabricated Knee Ankle Foot Orthosis Each Joint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.05 / $60.05 / $60.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.05 / $83.26 / $717.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$116.51 / $116.51 / $116.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.05 / $116.50 / $124.20
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.38 / $136.11 / $176.94
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$163.26 / $182.07 / $182.07
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.68 / $130.51 / $195.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.52 / $93.02 / $105.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.83 / $93.02 / $119.10