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Utah rates for HCPCS L5920

Addition, endoskeletal system, above knee (AK) or hip disarticulation, alignable system

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$204.17 / $204.17 / $204.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $380.19 / $2,754.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $398.11 / $398.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $288.40 / $489.78
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $616.60 / $794.33
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $741.31 / $1,288.25
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $602.56 / $707.95
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $851.14 / $851.14
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $851.14 / $851.14
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$158.49 / $316.23 / $478.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $316.23 / $478.63