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Utah rates for HCPCS L5628

Addition To Lower Extremity Test Socket Hemipelvectomy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.64 / $186.64 / $186.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.64 / $187.97 / $1,674.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$499.82 / $499.82 / $499.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$364.87 / $499.82 / $514.80
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$262.28 / $423.04 / $549.95
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$507.42 / $565.91 / $565.91
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$322.25 / $405.64 / $608.46
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$240.92 / $382.03 / $385.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$261.04 / $289.10 / $414.76