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Utah rates for HCPCS L5857

Addition To Lower Proximity Prosthesis Endoskeletal Knee-Shin System

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,970.74 / $2,970.74 / $2,970.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,970.74 / $3,251.77 / $28,958.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,652.12 / $6,652.12 / $6,652.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,856.05 / $6,652.12 / $6,851.68
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,696.05 / $7,574.29 / $9,846.57
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,085.04 / $10,132.20 / $10,132.20
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,769.63 / $7,262.77 / $10,894.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,154.88 / $4,601.64 / $6,601.65