go back

Utah rates for HCPCS L5643

Addition To Lower Extremity Hip Disarticulation Flexible Inner Socket External Frame

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$601.66 / $601.66 / $601.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$601.66 / $605.24 / $5,389.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,167.30 / $1,167.30 / $1,167.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$852.13 / $1,167.30 / $1,436.14
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,127.37 / $1,818.35 / $2,363.85
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,181.04 / $2,432.42 / $2,432.42
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,385.10 / $1,743.56 / $2,615.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$841.49 / $931.98 / $1,337.04