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Utah rates for HCPCS L2795

Addition to lower extremity orthosis, knee control, full kneecap

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.66 / $57.54 / $102.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.10 / $63.10 / $63.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.71 / $45.71 / $67.61
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.65 / $69.18 / $91.20
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.79 / $83.18 / $144.54
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.70 / $67.61 / $102.33
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $95.50 / $120.23
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.18 / $97.72 / $144.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.81 / $47.86 / $63.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.15 / $47.86 / $69.18