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Utah rates for HCPCS L5649

Addition to lower extremity, ischial containment/narrow M-L socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $741.31 / $741.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $1,380.38 / $10,000.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.70 / $1,819.70 / $1,819.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,318.26 / $2,089.30
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $1,862.09 / $2,398.83
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,905.46 / $2,238.72 / $3,890.45
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $1,819.70 / $2,570.40
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,290.87 / $2,570.40 / $2,570.40
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.09 / $2,570.40 / $2,951.21
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.96 / $1,148.15 / $1,698.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,148.15 / $1,698.24