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Utah rates for HCPCS L2628

Addition to lower extremity, pelvic control, metal frame, reciprocating hip joint and cables

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$607.91 / $607.91 / $607.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$607.91 / $644.57 / $5,445.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,179.41 / $1,179.41 / $1,179.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$860.97 / $1,179.40 / $1,354.05
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,139.06 / $1,837.20 / $2,388.36
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,203.66 / $2,457.65 / $2,457.65
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,399.48 / $1,761.64 / $2,642.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$723.46 / $941.64 / $1,205.68