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Utah rates for HCPCS L5696

Addition To Lower Extremity Above Knee Or Knee Disarticulation Pelvic Joint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.52 / $71.52 / $71.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.52 / $95.93 / $854.28
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.76 / $138.76 / $138.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.29 / $138.76 / $147.91
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.51 / $162.12 / $210.75
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.45 / $216.86 / $216.86
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.49 / $155.44 / $233.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.03 / $110.79 / $158.94