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Utah rates for HCPCS L5698

Addition To Lower Extremity Above Knee Or Knee Disarticulation Silesian Bandage

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.32 / $40.32 / $40.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.32 / $53.35 / $475.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.25 / $99.25 / $99.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.45 / $72.45 / $168.54
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.87 / $91.40 / $118.82
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.63 / $122.26 / $122.26
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.62 / $87.64 / $131.46
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.05 / $82.54 / $83.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.39 / $62.46 / $89.61