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Utah rates for HCPCS L5655

Addition To Lower Extremity Socket Insert Below Knee (Kemblo Pelite Aliplast Plastazote Or Equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.53 / $102.53 / $102.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.53 / $137.52 / $1,224.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$221.07 / $221.07 / $221.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.38 / $221.07 / $235.67
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.08 / $232.40 / $302.12
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$278.76 / $310.89 / $310.89
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.03 / $222.85 / $334.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$143.41 / $158.83 / $227.85