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Utah rates for HCPCS L5613

Addition To Lower Extremity Endoskeletal System Above Knee- Knee Disarticulation 4 Bar Linkage With Hydraulic Swing Phase Control

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$947.36 / $947.36 / $947.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$947.36 / $1,270.64 / $11,315.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,902.78 / $1,902.78 / $1,902.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,389.03 / $1,902.78 / $2,126.15
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,669.03 / $2,691.99 / $3,499.58
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,228.92 / $3,601.10 / $3,601.10
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,050.59 / $2,581.27 / $3,871.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,324.97 / $1,467.45 / $2,105.23