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Utah rates for HCPCS L5250

Hip Disarticulation Canadian Type; Molded Socket Hip Joint Single Axis Constant Friction Knee Shin Sach Foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,005.72 / $2,005.72 / $2,005.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,005.72 / $2,690.16 / $23,957.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,366.38 / $4,366.38 / $4,366.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,187.46 / $4,366.38 / $4,510.25
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,540.55 / $5,710.58 / $7,423.75
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,849.61 / $7,639.11 / $7,639.11
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,349.97 / $5,475.72 / $8,213.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,805.20 / $3,106.84 / $4,457.16