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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
$30.83 / $30.83 / $30.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.83 / $51.94 / $368.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.69 / $62.81 / $62.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.85 / $62.81 / $66.95
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.49 / $69.89 / $90.85
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.82 / $93.49 / $93.49
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.24 / $67.01 / $100.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.69 / $47.76 / $61.15