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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
$119.39 / $119.39 / $119.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.39 / $160.12 / $1,425.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.78 / $239.78 / $239.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.04 / $239.78 / $283.33
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$222.41 / $358.74 / $466.36
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$430.29 / $479.89 / $479.89
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$273.27 / $343.99 / $515.98
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$247.02 / $247.02 / $247.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.97 / $184.93 / $368.56