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Utah rates for HCPCS L5653

Addition to lower extremity, knee disarticulation, expandable wall socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$223.87 / $223.87 / $223.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $416.87 / $3,388.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $549.54 / $549.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $407.38 / $588.84
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $676.08 / $891.25
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$691.83 / $812.83 / $1,412.54
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $660.69 / $912.01
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $933.25 / $954.99
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $954.99 / $1,047.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.40 / $389.05 / $524.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $346.74 / $524.81