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Utah rates for HCPCS L2500

Addition to lower extremity, thigh/weight bearing, gluteal/ischial weight bearing, ring

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.82 / $114.82 / $114.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $199.53 / $2,041.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.47 / $245.47 / $245.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $177.83 / $251.19
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $257.04 / $338.84
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.03 / $309.03 / $537.03
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $251.19 / $380.19
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $354.81 / $389.05
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $363.08 / $467.74
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$147.91 / $177.83 / $234.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $177.83 / $257.04