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Utah rates for HCPCS L2622

Addition to lower extremity, pelvic control, hip joint, adjustable flexion, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$111.27 / $111.27 / $111.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.27 / $205.71 / $1,329.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$215.87 / $215.87 / $215.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$157.59 / $215.87 / $230.13
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.37 / $252.21 / $327.87
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.51 / $337.38 / $337.38
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$192.12 / $241.84 / $362.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.41 / $172.36 / $220.69