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Utah rates for HCPCS L2627

Addition to lower extremity, pelvic control, plastic, molded to patient model, reciprocating hip joint and cables

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$622.02 / $622.02 / $622.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$622.02 / $659.54 / $5,572.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,206.80 / $1,206.80 / $1,206.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$880.96 / $1,206.80 / $1,385.49
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,165.51 / $1,879.87 / $2,443.83
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,254.83 / $2,514.73 / $2,514.73
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,431.97 / $1,802.56 / $2,703.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$754.42 / $963.51 / $1,158.79