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Utah rates for HCPCS L2580

Addition to lower extremity, pelvic control, pelvic sling

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.82 / $169.82 / $169.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $323.59 / $3,019.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$371.54 / $371.54 / $371.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $275.42 / $380.19
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $501.19 / $645.65
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$512.86 / $602.56 / $1,047.13
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $489.78 / $660.69
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $676.08 / $691.83
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $691.83 / $758.58
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.78 / $263.03 / $346.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $263.03 / $371.54