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Utah rates for HCPCS L5626

Addition to lower extremity, test socket, hip disarticulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$181.97 / $181.97 / $181.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $302.00 / $2,818.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $489.78 / $489.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $363.08 / $524.81
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $416.87 / $537.03
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$426.58 / $501.19 / $870.96
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $407.38 / $616.60
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $575.44 / $676.08
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $588.84 / $794.33
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.88 / $331.13 / $426.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $288.40 / $426.58