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Utah rates for HCPCS L5648

Addition To Lower Extremity Above Knee Air Fluid Gel Or Equal Cushion Socket. (Rvsdf 1/1/04)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$254.51 / $254.51 / $254.51
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$254.51 / $256.01 / $2,279.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$589.44 / $589.44 / $589.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$430.29 / $589.44 / $628.37
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$476.87 / $769.16 / $999.90
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$922.58 / $1,028.92 / $1,028.92
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$585.90 / $737.53 / $1,106.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$355.95 / $394.23 / $565.57