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Utah rates for HCPCS L5677

Additions To Lower Extremity Below Knee Knee Joints Polycentric Pair

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.60 / $190.60 / $190.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.60 / $255.64 / $2,276.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$400.78 / $400.78 / $400.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.57 / $400.78 / $427.25
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$267.84 / $432.01 / $561.61
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$518.19 / $577.91 / $577.91
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$329.08 / $414.25 / $621.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$266.57 / $295.24 / $422.49