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Utah rates for HCPCS L5706

Custom shaped protective cover, knee disarticulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$354.81 / $354.81 / $354.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $588.84 / $5,128.61
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.99 / $954.99 / $954.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $691.83 / $1,023.29
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $870.96 / $1,122.02
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $1,047.13 / $1,819.70
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $851.14 / $1,288.25
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,202.26 / $1,202.26
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,202.26 / $1,445.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.09 / $724.44 / $812.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $549.54 / $812.83