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Utah rates for HCPCS L5616

Addition To Lower Extremity Endoskeletal System Above Knee Universal Multiplex System Friction Swing Phase Control

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$525.02 / $525.02 / $525.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$525.02 / $548.77 / $4,887.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,018.60 / $1,018.60 / $1,018.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$743.58 / $743.58 / $2,076.69
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$968.81 / $1,562.60 / $2,031.38
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,874.28 / $2,090.31 / $2,090.31
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,190.29 / $1,498.34 / $2,247.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$734.29 / $813.25 / $1,166.71