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
$602.56 / $602.56 / $602.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $1,122.02 / $8,128.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,174.90 / $1,174.90 / $1,174.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $851.14 / $1,445.44
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $1,819.70 / $2,344.23
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,862.09 / $2,187.76 / $3,801.89
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $1,778.28 / $2,290.87
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $2,511.89 / $2,511.89
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $2,511.89 / $2,630.27
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $933.25 / $1,412.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $933.25 / $1,412.54