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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
$352.30 / $352.30 / $352.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$352.30 / $385.84 / $3,436.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$957.73 / $957.73 / $957.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$699.14 / $957.73 / $1,020.99
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$538.95 / $869.28 / $1,130.06
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,042.66 / $1,162.83 / $1,162.83
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$662.15 / $833.53 / $1,250.29
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$595.23 / $595.23 / $595.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$492.72 / $545.71 / $893.18