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Utah rates for HCPCS L2624

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.15 / $120.15 / $120.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.15 / $169.86 / $1,435.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$291.02 / $291.02 / $291.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.45 / $291.02 / $310.26
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$168.85 / $272.33 / $354.04
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$326.67 / $364.32 / $364.32
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$207.45 / $261.14 / $391.71
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$155.10 / $186.11 / $211.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$145.72 / $186.11 / $229.44