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Utah rates for HCPCS L5795

Addition Exoskeletal System Hip Disarticulation Ultra-Light Material (Titanium Carbon Fiber Or Equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$415.05 / $415.05 / $415.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$415.05 / $433.95 / $3,864.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$908.11 / $908.11 / $908.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$662.92 / $662.92 / $1,508.94
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$583.28 / $940.78 / $1,223.01
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,128.42 / $1,258.48 / $1,258.48
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$716.63 / $902.08 / $1,353.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$580.49 / $642.91 / $922.34