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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
$184.31 / $184.31 / $184.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$184.31 / $212.41 / $1,891.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$493.58 / $493.58 / $493.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$360.31 / $493.58 / $526.19
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$259.01 / $417.76 / $543.08
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.09 / $558.84 / $558.84
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.23 / $400.58 / $600.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.77 / $285.49 / $409.58