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Utah rates for HCPCS L5676

Additions To Lower Extremity Below Knee Knee Joints Single Axis Pair

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.08 / $140.08 / $140.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.08 / $187.88 / $1,673.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$271.77 / $271.77 / $271.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$198.39 / $271.77 / $310.14
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$243.46 / $392.69 / $510.49
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$471.01 / $525.29 / $525.29
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$299.12 / $376.54 / $564.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$195.92 / $216.98 / $311.29