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Utah rates for HCPCS L5624

Addition To Lower Extremity Test Socket Above Knee

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.54 / $140.54 / $140.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.54 / $161.68 / $1,439.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$311.77 / $311.77 / $311.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$227.60 / $311.77 / $332.37
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$198.12 / $319.55 / $415.41
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$383.28 / $427.46 / $427.46
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$243.40 / $306.39 / $459.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$196.56 / $217.69 / $312.31