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Utah rates for HCPCS L5782

Addition To Lower Limb Prosthesis Vacuum Pump Residual Limb Volume Management And Moisture Evacuation System Heavy Duty

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,465.11 / $1,465.11 / $1,465.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,465.11 / $1,610.24 / $14,340.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,294.10 / $3,294.10 / $3,294.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,404.69 / $3,294.10 / $3,511.67
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,330.08 / $3,758.20 / $4,885.66
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,507.80 / $5,027.38 / $5,027.38
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,862.77 / $3,603.63 / $5,405.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,049.11 / $2,269.44 / $3,247.67