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Utah rates for HCPCS L5855

Addition, endoskeletal system, hip disarticulation, mechanical hip extension assist

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.23 / $120.23 / $120.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $223.87 / $2,137.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.88 / $239.88 / $239.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $173.78 / $281.84
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $354.81 / $467.74
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$363.08 / $426.58 / $741.31
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $354.81 / $524.81
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $489.78 / $501.19
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $501.19 / $602.56
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$154.88 / $245.47 / $281.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $186.21 / $275.42