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Utah rates for HCPCS L5850

Addition Endoskeletal System Above Knee Or Hip Disarticulation Knee Extension Assist

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.45 / $49.45 / $49.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.45 / $49.74 / $443.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.32 / $99.32 / $99.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.50 / $99.32 / $118.04
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.65 / $149.44 / $194.27
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$179.26 / $199.92 / $199.92
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.85 / $143.30 / $214.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.16 / $76.59 / $107.00