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Utah rates for HCPCS L2492

Addition to knee joint, lift loop for drop lock ring

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.15 / $37.15 / $37.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.15 / $69.18 / $575.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.20 / $91.20 / $91.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.61 / $67.61 / $97.72
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $104.71 / $138.04
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.15 / $125.89 / $218.78
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $102.33 / $128.82
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $144.54 / $147.91
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $147.91 / $147.91
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.86 / $56.23 / $66.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $57.54 / $81.28