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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
$736.00 / $736.00 / $736.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$736.00 / $745.18 / $6,636.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,800.00 / $1,800.00 / $1,800.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,314.00 / $1,800.00 / $2,110.78
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,151.68 / $1,857.55 / $2,414.81
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,228.05 / $2,484.86 / $2,484.86
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,414.97 / $1,781.15 / $2,671.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,029.36 / $1,140.05 / $1,635.55